Remote DRG Coding Auditor - MS/APR-DRG Specialist

Elevance Health; Chicago (IL); Hybrid; USD 93,000 - 160,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and generate recoverable claims across lines of business, ensuring accurate DRG assignment with MS-DRG and APR-DRG methodologies.

You will apply ICD-10 guidelines and clinical documentation principles in medical record reviews, supporting high-quality recoveries and audit findings while collaborating with hospitals and internal teams. The role offers hybrid/remote work with required in-person training.

Qualifications

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

Responsibilities

• Analyze and audit inpatient claims by integrating coding principles and clinical guidelines.
• Draw on ICD-10 coding expertise to substantiate conclusions.
• Utilize audit tools and workflow systems to generate audit findings letters.
• Maintain accuracy and quality standards for auditing concepts and documentation.
• Identify new claim types and opportunities for recoveries and improvements.

Skills

ICD-10 coding

Medical record auditing

Clinical documentation review

Education

AA/AS or equivalent

BA/BS preferred

Tools

Audit tools

DRG workflow systems

Job description

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and generate recoverable claims across lines of business, ensuring accurate DRG assignment with MS-DRG and APR-DRG methodologies.

You will apply ICD-10 guidelines and clinical documentation principles in medical record reviews, supporting high-quality recoveries and audit findings while collaborating with hospitals and internal teams. The role offers hybrid/remote work with required in-person training.