DRG Coding Auditor - MS-DRG and APR-DRG
Elevancehealth
Health Insurance
Norfolk, VA - USA
Senior Specialist / Project Manager
Hybrid
Experteer Overview
In this role you audit inpatient records to ensure accurate DRG assignments and recoverable claims across lines of business. You will apply ICD-10 coding principles and clinical guidelines to support precise reimbursements. You’ll use audit tools to generate findings and help drive process improvements in coding quality. You will work with cross-functional teams to identify opportunities for higher value recoveries and ensure compliant documentation. This position supports a hybrid/remote work setup with on-site onboarding and training.
Compensation / Benefits
- sign-on bonus
- comprehensive benefits package
- 401(k) + match
- stock purchase plan
- paid holidays
- paid time off
Responsibilities
- Audit inpatient medical records to assess DRG accuracy and generate high-quality claims
- Apply ICD-10 coding knowledge and clinical guidelines to substantiate audit conclusions
- Use audit tools and workflows to determine findings and craft evaluation letters
- Ensure accuracy and quality standards in documentation and claim identification
- Identify new claim types and recovery opportunities (e.g., readmissions, HACs)
- Propose process improvements to enhance efficiency and accuracy in coding/audit processes
Key requirements
- AA/AS or 5+ years of claims auditing/quality assurance/recovery auditing experience
- RHIA, RHIT, CCS, CIC, CCDS certifications (any one)
- 5+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG
Description
In this role you audit inpatient records to ensure accurate DRG assignments and recoverable claims across lines of business. You will apply …
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