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Elevance Health Remote DRG Coding Auditor in Deerfield, Illinois

Remote DRG Coding Auditor

  • Job Family: Medical and Clinical

  • Type: Full time

  • Date Posted:Jul 25, 2022

  • Req #: PS74714


  • Illinois, Chicago

  • Indiana, Indiana

  • Texas, Texas

  • Michigan, Michigan

  • Virginia, Virginia

  • Pennsylvania, Pennsylvania

  • Illinois, Illinois

  • New York, New York

  • California, California


Job Title: Remote DRG Coding Auditor

Location: Remote/Work From Home (Considering candidates throughout the United States)

*Selected candidate must ensure work at home office is in a dedicated private and secure room adhering to HIPPA compliance regulations.

Working Hours : M-F | 8am-5pm

Training/Orientation Schedule : Mon-Friday (8:00 am-5:00 pm Est.) for the first 3 weeks of training.

How you will make an impact:

Responsible for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of the company, all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in the review of DRG coding via medical records and attending physician’s statements sent in by acute care hospitals on submitted DRG.

Primary duties may include, but are not limited to:

Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.

Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.

Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.

Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing). Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and HACs.

Suggests and develops high-quality, high-value concept and or process improvement and efficiency recommendations.

Minimum Requirements:

Requires at least one of the following: AA/AS or a minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.

Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Cert Coding Specialist and/or CIC as a Certified Inpatient Coder.*

*Candidates with CIC must have one of the other licenses listed in addition to the CIC.

Preferred Skills, Capabilities, and Experiences:

BA/BS preferred.

Experience with vendor-based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred.

Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.

Experience with 3M and/or TruCode is highly desirable.

Level 1 trauma or community hospital experience is critical and highly desirable in this role.

A strong coding background is highly desirable.

Experience with APR-DRG is a huge plus and highly desirable.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.

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