Remote DRG Coding Auditor - MS-DRG & APR-DRG

Elevance Health; Costa Mesa (CA); Hybrid; USD 93,000 - 160,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor to review inpatient records and ensure accurate DRG assignments. You will conduct clinical reviews, leverage ICD-10 coding expertise, and document audit findings. Hybrid/remote work with occasional in-person training supports this role.

The position emphasizes high-quality recoverable claims across lines of business, using audit tools and established guidelines. A strong background in MS-DRG, AP-DRG, and APR-DRG is essential.

Qualifications

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

Responsibilities

• Audit inpatient records and generate high-quality recoverable claims for all lines of business.
• Conduct clinical reviews to evaluate coding and DRG assignment accuracy.
• Use ICD-10 expertise and guidelines to support audit conclusions.
• Maintain audit documentation and letters, identify new claim types for recovery opportunities.
• Recommend process improvements to enhance audit quality and efficiency.

Skills

ICD-10 coding

Audit proficiency

Education

BA/BS preferred

Tools

Audit workflow systems

Job description

Elevance Health is seeking a DRG Coding Auditor to review inpatient records and ensure accurate DRG assignments. You will conduct clinical reviews, leverage ICD-10 coding expertise, and document audit findings. Hybrid/remote work with occasional in-person training supports this role.

The position emphasizes high-quality recoverable claims across lines of business, using audit tools and established guidelines. A strong background in MS-DRG, AP-DRG, and APR-DRG is essential.