Remote DRG Coding Auditor – MS/APR-DRG Expert

ANTHEM INSURANCE COMPANIES INC; Chicago (IL); Remote; USD 93,000 - 160,000; Full time

Benefits offered by this job

Sign On Bonus: $1,500

Remote/Virtual work option

Job summary

ANTHEM INSURANCE COMPANIES INC is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality, recoverable claims across lines of business. The role requires expertise in MS-DRG, AP-DRG, APR-DRG and clinical chart review for coding accuracy.

The position offers virtual work with in-person training sessions. Flexibility for alternate locations within commuting distance may apply, with compliance to hybrid/virtual policies.

Qualifications

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

Responsibilities

• Audits inpatient medical records and DRG assignments ensuring accuracy and recoveries.
• Applies ICD-10 coding guidelines and DRG concepts to substantiate conclusions.
• Uses audit tools and workflows to create audit determinations and letters.
• Identifies opportunities for additional recoveries (readmissions, HACs, etc.).
• Suggests process improvements to enhance accuracy and efficiency.

Skills

Claims auditing

DRG coding

ICD-10 coding

Quality assurance

Medical records

Education

AA/AS degree

BA/BS preferred

Job description

ANTHEM INSURANCE COMPANIES INC is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality, recoverable claims across lines of business. The role requires expertise in MS-DRG, AP-DRG, APR-DRG and clinical chart review for coding accuracy.

The position offers virtual work with in-person training sessions. Flexibility for alternate locations within commuting distance may apply, with compliance to hybrid/virtual policies.