Elevance Health
Base Pay Range
$111,040.00/yr - $199,872.00/yr
Role Summary Manager of DRG Coding Audit – Program/Project
Location / Remote Options Selected candidate must reside within a reasonable commuting distance of: Virginia, Indiana, Georgia, Ohio, District of Columbia (Washington, DC), Maryland, New Jersey, New York and Texas.
Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
About the Company Carelon Payment Integrity is a proud member of the Elevance Health family of companies. Formerly Payment Integrity, Carelon Insights is determined to recover, eliminate and prevent unnecessary medical‑expense spending.
About the Role The Manager of DRG Coding Audit 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 plays a critical part in identifying coding discrepancies and recoverable claim opportunities, and supporting regulatory integrity on behalf of the company and its clients.
How You Will Make An Impact
Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry's best practices and payer‑specific requirements.
Collaborates cross‑functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Analyzes audit trends, DRG shifts, and uses financial outcomes to inform strategy.
Plans program/project scope and design.
Develops metrics and program/project reporting tools.
Analyzes variance to program/project plan.
Leads building of documentation to support business objectives and ensure consistency.
Is responsible for championing local stakeholders and tactical decision‑makers.
Suggests and develops high‑quality, high‑value concepts and process‑improvement and efficiency recommendations.
Draws on advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
Minimum Requirements
BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or an equivalent combination of education and experience.
Travels to worksite and other locations as necessary.
Preferred Skills, Capabilities and Experiences
Minimum of 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity.
Experience working 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.
Compensation and Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution.
Salary for this position is $111,040 to $199,872. This range is subject to geographic location, work experience, education and skill level.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of posting. This range may be modified in the future and actual compensation may vary based on location, experience and other factors.
Equal Opportunity Employer 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, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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Role Summary Manager of DRG Coding Audit – Program/Project
Location / Remote Options Selected candidate must reside within a reasonable commuting distance of: Virginia, Indiana, Georgia, Ohio, District of Columbia (Washington, DC), Maryland, New Jersey, New York and Texas.
Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
About the Company Carelon Payment Integrity is a proud member of the Elevance Health family of companies. Formerly Payment Integrity, Carelon Insights is determined to recover, eliminate and prevent unnecessary medical‑expense spending.
About the Role The Manager of DRG Coding Audit 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 plays a critical part in identifying coding discrepancies and recoverable claim opportunities, and supporting regulatory integrity on behalf of the company and its clients.
How You Will Make An Impact
Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry's best practices and payer‑specific requirements.
Collaborates cross‑functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Analyzes audit trends, DRG shifts, and uses financial outcomes to inform strategy.
Plans program/project scope and design.
Develops metrics and program/project reporting tools.
Analyzes variance to program/project plan.
Leads building of documentation to support business objectives and ensure consistency.
Is responsible for championing local stakeholders and tactical decision‑makers.
Suggests and develops high‑quality, high‑value concepts and process‑improvement and efficiency recommendations.
Draws on advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
Minimum Requirements
BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or an equivalent combination of education and experience.
Travels to worksite and other locations as necessary.
Preferred Skills, Capabilities and Experiences
Minimum of 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity.
Experience working 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.
Compensation and Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution.
Salary for this position is $111,040 to $199,872. This range is subject to geographic location, work experience, education and skill level.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of posting. This range may be modified in the future and actual compensation may vary based on location, experience and other factors.
Equal Opportunity Employer 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, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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