Remote Principal DRG Coding Auditor

Elevance Health; Cleveland (OH); Hybrid; USD 122,000 - 183,000; Full time

Benefits offered by this job

comprehensive benefits package

incentive and recognition programs

401k contribution

stock purchase plan

merit increases

Paid Time Off

Job summary

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient medical records and DRG-based claims across lines of business. The role requires expert ICD-10 coding knowledge and sophisticated audit capabilities.

You will work with management on criteria, perform secondary reviews, and identify opportunities for optimal recoveries. Hybrid work setup involves weekly in-office sessions and remote collaboration.

Qualifications

• AA/AS or 15+ years experience in claims auditing, quality assurance, or recovery auditing.
• RHIA, RHIT, CCS, CIC, or CCDS certification required or preferred.
• Minimum of 10 years experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audit inpatient claims using DRG methodologies and medical record documentation.
• Substantiate conclusions with ICD-10 coding guidelines, Coding Clinics, and ICD references.
• Use audit tools and workflow systems to generate audit findings letters.
• Validate accuracy and quality standards for audit concepts and documentation.
• Identify new claim types and opportunities for recoveries (readmissions, HACs, PAEs, Never Events).
• Collaborate with management to improve selection criteria and process.

Skills

ICD-10 coding expertise

Claims auditing

Auditing principles

Clinical guidelines

Education

AA/AS

RHIA/RHIT/CCS/CIC/CCDS certifications

Job description

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient medical records and DRG-based claims across lines of business. The role requires expert ICD-10 coding knowledge and sophisticated audit capabilities.

You will work with management on criteria, perform secondary reviews, and identify opportunities for optimal recoveries. Hybrid work setup involves weekly in-office sessions and remote collaboration.