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

Elevance Health; Town of Florida (NY); Remote; USD 93,000 - 160,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and ensure accurate MS-DRG/AP-DRG assignments across all lines of business. The role focuses on generating high-quality recoverable claims and performing clinical reviews to assess coding accuracy.

The position supports virtual work with required in-person training, and relocation within reasonable commuting distance may be considered.

Qualifications

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

Responsibilities

• Audits inpatient medical records to validate DRG assignments.
• Generates high-quality recoverable claims across all lines of business.
• Uses ICD-10 coding principles and clinical guidelines to substantiate conclusions.
• Writes audit findings letters and supports process improvement.

Skills

ICD-10 coding

Claims auditing

Clinical reviews

Audit procedures

Education

AA/AS

BA/BS preferred

Tools

DRG Coding Systems

Job description

Elevance Health is seeking a DRG Coding Auditor to audit inpatient medical records and ensure accurate MS-DRG/AP-DRG assignments across all lines of business. The role focuses on generating high-quality recoverable claims and performing clinical reviews to assess coding accuracy.

The position supports virtual work with required in-person training, and relocation within reasonable commuting distance may be considered.