Remote DRG Auditor – MS/APR-DRG Claims

Elevance Health, Inc.; Chicago, Costa Mesa, Indianapolis, New York (IL, CA, IN, NY); Ibrido; USD 93.000 - 160.000; Tempo pieno

Vantaggi offerti da questo lavoro

Hybrid work model

Descrizione del lavoro

Elevance Health, Inc. is seeking a DRG Coding Auditor - MS-DRG and APR-DRG to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role includes clinical reviews to ensure accurate DRG assignments and adherence to coding guidelines.

The candidate will leverage ICD-10 coding expertise and auditing tools within a hybrid/virtual work model, with some in-person training and occasional office presence as needed.

Competenze

• AA/AS or 5+ years claims auditing experience required.
• RHIA/RHIT/CCS/CIC/CCDS credentials are required or preferred.
• 5 years of ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG experience.

Mansioni

• Audit inpatient records and generate high quality recoverable claims.
• Perform clinical reviews to evaluate DRG assignment accuracy.
• Use advanced ICD-10 coding principles and guidelines in audits.
• Identify new claim types and opportunities for additional recoveries.
• Propose process improvements to increase efficiency and quality.

Conoscenze

ICD-10 coding expertise

Auditing skills

Clinical guidelines knowledge

Formazione

AA/AS degree

BA/BS degree preferred

Strumenti

Audit tools

Workflow systems

Descrizione del lavoro

Elevance Health, Inc. is seeking a DRG Coding Auditor - MS-DRG and APR-DRG to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role includes clinical reviews to ensure accurate DRG assignments and adherence to coding guidelines.

The candidate will leverage ICD-10 coding expertise and auditing tools within a hybrid/virtual work model, with some in-person training and occasional office presence as needed.