DRG Coding Auditor

Elevance Health is seeking a DRG Coding Auditor to ensure accurate, compliant inpatient reimbursement and support whole-health care for our members. In this remote role, you will perform detailed retrospective and prospective DRG audits, reviewing medical records and ICD-10-CM/PCS codes to validate MS-DRG/APR-DRG assignments and identify documentation gaps. You'll collaborate with coders, clinicians, and compliance teams, prepare clear audit reports, and deliver education that improves coding quality. Join a mission-driven, inclusive culture with strong benefits, growth opportunities, and a focus on innovation, learning, and work-life balance.

Responsibilities

• Perform retrospective and prospective inpatient DRG coding audits for accuracy and compliance

• Review medical records, physician documentation, and codes (ICD-10-CM/PCS) to validate MS-DRG/APR-DRG assignment

• Identify coding, sequencing, and documentation issues impacting reimbursement and quality metrics

• Prepare clear audit findings, summaries, and education feedback for coders and providers

• Collaborate with coding, clinical, and compliance teams to resolve discrepancies and implement corrective actions

• Monitor trends, perform root cause analysis, and recommend process improvements to reduce coding errors

• Stay current on coding guidelines, payer rules, and regulatory changes impacting DRG assignment

• Support training, education, and quality initiatives aligned with Elevance Health's mission and policies Required Skills

• DRG coding

• ICD-10-CM/PCSmedical record auditinginpatient coding

• MS-DRG/APR-DRG groupingclinical documentation review

• Medicare/Medicaid regulationscoding compliancedata analysisaudit reporting

• EHR systems

• Microsoft Excelroot cause analysisquality improvement

• HIPAA compliance