DRG Coding Auditor - MS-DRG and APR-DRG

Elevancehealth

Health Insurance

Costa Mesa, CA - USA

Senior Specialist / Project Manager

Hybrid

Experteer Overview

As a DRG Coding Auditor, you will audit inpatient medical records to ensure high-quality, recoverable claims across lines of business. You will apply ICD-10 coding knowledge, clinical guidelines, and audit tools to support accurate DRG assignments. The role blends individual focus with collaboration to drive improvements in coding quality and process efficiency. This position offers virtual work with in-person onboarding, emphasizing flexibility and professional growth. You will contribute to a mission-driven healthcare company that values precise, compliant coding and continuous improvement.

Compensation / Benefits

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401(k) + match
stock purchase plan
life insurance

Responsibilities

Audit inpatient claims to ensure accurate DRG assignments
Apply ICD-10 coding principles and clinical guidelines in audits
Use audit tools and workflow systems to generate findings and letters
Maintain accuracy and quality standards for audits and documentation
Identify new claim types and opportunities for additional recoveries
Suggest high-quality process improvements to enhance efficiency

Key requirements

AA/AS or minimum 5 years of experience in claims auditing, quality assurance, or recovery auditing
RHIA / RHIT / CCS / CIC / CCDS certifications
5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG

attention to detail strong analytical thinking clear written and verbal communication ICD-9/10CM MS-DRG AP-DRG

Description

As a DRG Coding Auditor, you will audit inpatient medical records to ensure high-quality, recoverable claims across lines of business. You w…

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