Remote DRG Coding Auditor (MS/APR-DRG)

DaMar Staffing; Norfolk (VA); Hybrid; USD 93,000 - 160,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor – MS-DRG and APR-DRG to audit inpatient records, review coding accuracy, and support recoveries across lines of business. The role supports a virtual, hybrid work model with in-person training sessions and occasional onsite requirements.

Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG is essential, with RHIA/RHIT/CCS/CIC/CCDS certifications preferred. Opportunities span multiple U.S.

Qualifications

• Requires at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• Requires 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• CCDS, CIC, CCS, RHIA or RHIT certifications are preferred.

Responsibilities

• Audits inpatient medical records and generates high quality recoverable claims for the company and its clients.
• Performs clinical reviews of medical records to evaluate DRG assignment accuracy.
• Specializes in DRG coding review via medical records and physician statements from hospitals.
• Analyzes and audits claims by integrating coding principles and clinical guidelines.
• Uses ICD-10 coding expertise to substantiate audit conclusions.
• Uses auditing tools and workflows to issue audit determinations and letters.
• Maintains accuracy and quality standards for the auditing process and documentation.
• Identifies new claim types for potential additional recoveries.

Skills

Auditing

Medical coding

ICD-10 coding

DRG knowledge

Analytical thinking

Education

AA/AS

Bachelor's degree

Job description

Elevance Health is seeking a DRG Coding Auditor – MS-DRG and APR-DRG to audit inpatient records, review coding accuracy, and support recoveries across lines of business. The role supports a virtual, hybrid work model with in-person training sessions and occasional onsite requirements.

Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG is essential, with RHIA/RHIT/CCS/CIC/CCDS certifications preferred. Opportunities span multiple U.S.