Elevance Health
Manager of DRG Coding Audit
Location:
District of Columbia (Washington, DC); Maryland; New Jersey; New York. Hybrid 2:
3 days in‑office, 2 days virtual.
Overview:
Leads a high‑performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis‑Related Group (DRG) assignments. This role identifies coding discrepancies, supports recoverable claim opportunities, and upholds regulatory integrity for the company and its clients.
How You Will Make an Impact
Set strategic direction for audit methodologies and ensure audits adhere to industry best practices and payer‑specific requirements.
Collaborate cross‑functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
Hire, train, coach, counsel, and evaluate direct reports.
Analyze audit trends, DRG shifts, and use financial outcomes to inform strategy.
Plan program/project scope and design.
Develop metrics and reporting tools to monitor program performance.
Identify variance from plan and lead initiatives to rectify it.
Build documentation that supports business objectives and ensures consistency.
Champion stakeholder engagement and facilitate tactical decision‑making.
Recommend high‑value process improvements based on advanced ICD‑10 coding expertise and clinical guidelines.
Minimum Requirements
BA/BS degree and a minimum of 5 years of project/program management, process reengineering, organizational design, and/or implementation experience (or equivalent).
Travel to work sites and other locations as necessary.
Preferred Skills, Capabilities and Experiences
5–7 years of inpatient coding or DRG auditing experience, including 2–3 years in a leadership or supervisory capacity.
Experience with ICD‑9/10CM, MS‑DRG, and APR‑DRG.
Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
Salary and Benefits Salary: $111,040 – $199,872 (salary range based on location, experience, and skills).
Benefits include a comprehensive health package, incentive and recognition programs, equity stock purchase plan, 401(k) match, and other benefits subject to eligibility.
Equal Employment Opportunity 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, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable law. Applicants who require accommodation may contact elevancehealthjobssupport@elevancehealth.com.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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District of Columbia (Washington, DC); Maryland; New Jersey; New York. Hybrid 2:
3 days in‑office, 2 days virtual.
Overview:
Leads a high‑performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis‑Related Group (DRG) assignments. This role identifies coding discrepancies, supports recoverable claim opportunities, and upholds regulatory integrity for the company and its clients.
How You Will Make an Impact
Set strategic direction for audit methodologies and ensure audits adhere to industry best practices and payer‑specific requirements.
Collaborate cross‑functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
Hire, train, coach, counsel, and evaluate direct reports.
Analyze audit trends, DRG shifts, and use financial outcomes to inform strategy.
Plan program/project scope and design.
Develop metrics and reporting tools to monitor program performance.
Identify variance from plan and lead initiatives to rectify it.
Build documentation that supports business objectives and ensures consistency.
Champion stakeholder engagement and facilitate tactical decision‑making.
Recommend high‑value process improvements based on advanced ICD‑10 coding expertise and clinical guidelines.
Minimum Requirements
BA/BS degree and a minimum of 5 years of project/program management, process reengineering, organizational design, and/or implementation experience (or equivalent).
Travel to work sites and other locations as necessary.
Preferred Skills, Capabilities and Experiences
5–7 years of inpatient coding or DRG auditing experience, including 2–3 years in a leadership or supervisory capacity.
Experience with ICD‑9/10CM, MS‑DRG, and APR‑DRG.
Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology.
Salary and Benefits Salary: $111,040 – $199,872 (salary range based on location, experience, and skills).
Benefits include a comprehensive health package, incentive and recognition programs, equity stock purchase plan, 401(k) match, and other benefits subject to eligibility.
Equal Employment Opportunity 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, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable law. Applicants who require accommodation may contact elevancehealthjobssupport@elevancehealth.com.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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