Senior DRG Coding Auditor - Remote

Socket.dev; Indiana (PA); Hybrid; USD 122,000 - 183,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient records and DRG-based claims across multiple lines of business. You will handle highly complex coding cases and generate actionable recovery findings.

The role supports hybrid/virtual work with required in-person training, and expects extensive ICD-10 coding expertise, DRG knowledge, and senior auditing experience. Located in a policy-driven healthcare environment with strong compliance expectations.

Qualifications

• Requires strong knowledge of ICD-9/10CM and DRG methodologies.
• Experience with MS-DRG, APR-DRG, AP-DRG and related coding schemes.
• Certified coding credentials are preferred.

Responsibilities

• Audits inpatient medical records and DRG-based claims across lines of business.
• Reviews complex cases using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methods.
• Generates high-quality audit findings and recovery recommendations.
• collaborates with management to improve criteria and processes.
• Operates with high independence and delivers precise audit outputs.
• Performs secondary audits to identify gaps in foundational knowledge.

Skills

ICD-10 coding

Auditing principles

Education

AA/AS or 15+ years claims auditing experience

RN license

BA/BS preferred

Job description

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient records and DRG-based claims across multiple lines of business. You will handle highly complex coding cases and generate actionable recovery findings.

The role supports hybrid/virtual work with required in-person training, and expects extensive ICD-10 coding expertise, DRG knowledge, and senior auditing experience. Located in a policy-driven healthcare environment with strong compliance expectations.