Remote DRG Auditor: MS-DRG & APR-DRG Claims & Coding

Elevance Health (Anthem); Chicago (IL); On-site; USD 93,000 - 160,000; Full time

Benefits offered by this job

Sign-on bonus $1,500

Job summary

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and ensure high-quality recoverable claims. The role requires strong ICD-10 coding knowledge and MS-DRG/AP-DRG experience, with in-person training in addition to virtual work as applicable.

Hybrid/remote options are possible, with travel or onsite sessions as required by training. Salary range reflects location-based variation within the United States.

Qualifications

• AA/AS or 5+ years in claims auditing, QA, or recovery auditing.
• RHIA/RHIT/CCS/CIC/CCDS certification(s).
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audits inpatient medical records and generates recoverable claims for all lines of business.
• Performs clinical reviews to evaluate coding and DRG assignment accuracy.
• Reviews DRG coding via medical records and attending physicians' statements for acute care hospitals.
• Identifies new claim types and opportunities for additional recoveries (e.g., readmissions, HACs).

Skills

ICD-10 coding

MS-DRG/AP-DRG

Auditing

Clinical validation

Education

AA/AS degree

Tools

Audit tools

Job description

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and ensure high-quality recoverable claims. The role requires strong ICD-10 coding knowledge and MS-DRG/AP-DRG experience, with in-person training in addition to virtual work as applicable.

Hybrid/remote options are possible, with travel or onsite sessions as required by training. Salary range reflects location-based variation within the United States.