DRG Coding Auditor – MS-DRG, APR-DRG

🔥 0 minutes ago

🏄 California, Illinois, +3 more states – Remote

🏄 California – Remote 🌽 Illinois – Remote 🗽 New York – Remote 🦀 Maryland – Remote ⚔️ Virginia – Remote

💵 $92.9k - $160.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Audit inpatient medical records and generate high-quality recoverable claims for the company, its lines of business, and clients • Perform clinical reviews of medical records and documentation to evaluate coding and DRG assignment accuracy • Review DRG coding based on medical records and attending physicians’ statements from acute care hospitals • Analyze and audit claims using medical chart coding principles, clinical guidelines, and objective medical audit practices • Apply advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions • Use audit tools, workflow systems, and reference information to make audit determinations and generate audit findings letters • Maintain accuracy and quality standards for auditing concepts, valid claim identification, and documentation • Identify new claim types and potential additional recoveries, including readmissions, inpatient-to-outpatient cases, and HACs • Suggest and develop high-quality, high-value concept, process improvement, and efficiency recommendations

🎯 Requirements

• AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing • RHIA, RHIT, CCS, CIC, or Certified Clinical Documentation Specialist (CCDS) certification • 5 years of experience working with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG • BA/BS preferred • Experience with vendor-based DRG coding or clinical validation audit settings, hospital coding, or quality assurance environments preferred • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology preferred • Candidates must reside within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law • New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and influenza, unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Required in-person training sessions • Maximum flexibility and autonomy • Work-life integration