Remote DRG Clinical Auditor Principal

The Elevance Health Companies, Inc.; Mason (OH); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Elevance Health is seeking a DRG Clinical Auditor Principal to audit inpatient medical records and DRG-based claims across lines of business. You will handle very complex coding cases and generate actionable audit findings for recoveries.

The role requires extensive ICD-9/10CM and DRG experience, advanced auditing capability, and autonomy, with hybrid work arrangements and in-person training as needed.

Qualifications

• AA/AS or minimum of 15 years of experience in claims auditing.
• RHIA/RHIT/CCS/CIC/CCDS certification required.
• Minimum of 10 years experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• BA/BS preferred.

Responsibilities

• Audits inpatient medical records on claims paid based on DRG methodology across all lines of business.
• Specializes in DRG coding review using complex coding cases (APS-DRG, APR-DRG, AP-DRG, MS-DRG, TRICARE).
• Analyzes complex guidelines, uses audit tools to generate findings letters.
• Identifies new claim types and opportunities for recoveries; suggests process improvements.
• Operates largely independently with minimal oversight and collaborates with management to improve criteria.

Skills

ICD-9/10CM experience

DRG auditing

Audit reporting

Analytical thinking

Education

AA/AS; 15 years claims auditing

BA/BS preferred

Tools

Audit workflow systems

Job description

Elevance Health is seeking a DRG Clinical Auditor Principal to audit inpatient medical records and DRG-based claims across lines of business. You will handle very complex coding cases and generate actionable audit findings for recoveries.

The role requires extensive ICD-9/10CM and DRG experience, advanced auditing capability, and autonomy, with hybrid work arrangements and in-person training as needed.