Remote Senior DRG Clinical Auditor

Elevance Health; Mason (OH); Hybrid; USD 110,000 - 160,000; Full time

Job summary

Elevance Health seeks a DRG Clinical Auditor Principal to audit inpatient medical records and complex DRG coding across lines of business. The role emphasizes autonomy, high-quality output, and expertise in DRG methodologies and coding guidelines.

The ideal candidate brings extensive ICD-10/DRG experience, a strong audit track record, and the ability to work largely independently while collaborating with management on improvements and opportunities.

Qualifications

• AA/AS degree or 15+ years in claims auditing/quality assurance/recovery auditing.
• Minimum of 10 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• BA/BS preferred; coding accuracy and regulatory compliance are essential.

Responsibilities

• Audit inpatient medical records for DRG-based claims using advanced coding guidelines.
• Generate complex audit findings and recoveries for multiple lines of business.
• Collaborate with management to refine selection criteria and processes.

Skills

ICD-10 expertise

DRG auditing

Quality assurance

Independent work

Education

AA/AS degree

Tools

DRG Coding tools

Job description

Elevance Health seeks a DRG Clinical Auditor Principal to audit inpatient medical records and complex DRG coding across lines of business. The role emphasizes autonomy, high-quality output, and expertise in DRG methodologies and coding guidelines.

The ideal candidate brings extensive ICD-10/DRG experience, a strong audit track record, and the ability to work largely independently while collaborating with management on improvements and opportunities.