Remote DRG Coding Auditor - MS/APR-DRG Expertise

ANTHEM INSURANCE COMPANIES INC; Norfolk (VA); Remote; USD 93.000 - 160.000; Vollzeit

Zusammenfassung

ANTHEM INSURANCE COMPANIES INC is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality recoverable claims across all lines of business. The role requires strong clinical review skills and mastery of DRG assignments via DRG, AP-DRG, and APR-DRG methodologies.

The auditor will apply ICD-10 coding principles, clinical guidelines, and audit tools to support accurate coding and documentation while identifying opportunities for additional recoveries.

Qualifikationen

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

Aufgaben

• Analyzes and audits inpatient claims by integrating chart coding principles, clinical guidelines and audit objectivity.
• Draws on ICD-10 coding expertise and industry knowledge to substantiate audit conclusions.
• Uses audit tools and workflow systems to make determinations and generate audit findings letters.
• Maintains accuracy and quality standards for auditing concepts and documentation (e.g., letters).
• Identifies new claim types and potential recoveries beyond standard concepts (e.g., readmissions, HACs).
• Suggests and develops high-value process improvement recommendations.

Kenntnisse

ICD-10 coding

Auditing

Clinical guidelines

Data analysis

Ausbildung

AA/AS or 5+ years experience

RHIA

RHIT

CCS

CIC

CCDS

Jobbeschreibung

ANTHEM INSURANCE COMPANIES INC is seeking a DRG Coding Auditor to audit inpatient medical records and generate high-quality recoverable claims across all lines of business. The role requires strong clinical review skills and mastery of DRG assignments via DRG, AP-DRG, and APR-DRG methodologies.

The auditor will apply ICD-10 coding principles, clinical guidelines, and audit tools to support accurate coding and documentation while identifying opportunities for additional recoveries.