Senior DRG Coding Auditor - Remote & Complex Claims

Elevance Health; Kentucky; On-site; USD 122,000 - 183,000; Full time

Job summary

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient medical records using DRG methodologies across multiple lines of business. The role emphasizes highly complex coding cases and independent work with minimal oversight.

Responsibilities include applying ICD-10 coding guidelines, validating documentation quality, and generating detailed audit findings letters for recovery opportunities. A strong track record in DRG audits and certifications is required.

Qualifications

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

Responsibilities

• Analyzes and audits claims using advanced coding principles and ICD-10 guidelines.
• Substantiates conclusions with ICD-10 coding expertise and clinical guidelines.
• Uses auditing tools and workflow systems to make determinations and draft audit letters.
• Ensures accuracy and quality standards for audit outputs and documentation.

Skills

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

Education

RHIA

RHIT

CCS

CIC

CCDS

Job description

Elevance Health is seeking a DRG Coding Auditor Principal to audit inpatient medical records using DRG methodologies across multiple lines of business. The role emphasizes highly complex coding cases and independent work with minimal oversight.

Responsibilities include applying ICD-10 coding guidelines, validating documentation quality, and generating detailed audit findings letters for recovery opportunities. A strong track record in DRG audits and certifications is required.