Elevance Health
Managers of DRG Coding & Clinical Validation Audit
Two days ago – Be among the first 25 applicants. This position is offered by Elevance Health and pay is based on skills and experience.
Base pay range : $111,040.00/yr – $199,872.00/yr.
Role Summary : The Manager of DRG Coding – Program/Project leads a high‑performing team that audits inpatient medical records to ensure accurate and compliant Diagnosis‑Related Group (DRG) assignments. The role supports regulatory integrity, identifies coding discrepancies, recovers claim opportunities, and works cross‑functionally to align audit insights with broader program goals.
Location : Candidates must reside reasonably close to the designated posting location (Virginia, Indiana, Georgia, Ohio, District of Columbia, Maryland, New Jersey, New York, Texas). The role is hybrid – in‑office three days per week with flexibility for virtual work when permissible. Candidates outside a reasonable commuting distance will not be considered unless an accommodation is granted.
How You Will Make An Impact
Set strategic direction for audit methodologies and oversee team development.
Ensure audits meet industry best practices and payer‑specific requirements.
Collaborate with clinical, compliance, provider engagement, and data analytics teams.
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 program/project reporting tools.
Analyze variance to program/project plan.
Lead documentation building to support business objectives and ensure consistency.
Champion local stakeholders and tactical decision‑makers.
Suggest and develop high quality, high value concepts or process improvements.
Apply advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
Minimum Requirements
BA/BS and a minimum of 5 years’ experience in project/program management, process reengineering, organizational design, or implementation. Equivalent experience is acceptable.
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.
Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contributions, and more. Salary is based on legitimate, non‑discriminatory factors and may vary by location, experience, and other considerations.
We are an Equal Employment Opportunity employer. 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 expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law. Applicants requiring accommodations for the application process may contact elevancehealthjobssupport@elevancehealth.com.
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Base pay range : $111,040.00/yr – $199,872.00/yr.
Role Summary : The Manager of DRG Coding – Program/Project leads a high‑performing team that audits inpatient medical records to ensure accurate and compliant Diagnosis‑Related Group (DRG) assignments. The role supports regulatory integrity, identifies coding discrepancies, recovers claim opportunities, and works cross‑functionally to align audit insights with broader program goals.
Location : Candidates must reside reasonably close to the designated posting location (Virginia, Indiana, Georgia, Ohio, District of Columbia, Maryland, New Jersey, New York, Texas). The role is hybrid – in‑office three days per week with flexibility for virtual work when permissible. Candidates outside a reasonable commuting distance will not be considered unless an accommodation is granted.
How You Will Make An Impact
Set strategic direction for audit methodologies and oversee team development.
Ensure audits meet industry best practices and payer‑specific requirements.
Collaborate with clinical, compliance, provider engagement, and data analytics teams.
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 program/project reporting tools.
Analyze variance to program/project plan.
Lead documentation building to support business objectives and ensure consistency.
Champion local stakeholders and tactical decision‑makers.
Suggest and develop high quality, high value concepts or process improvements.
Apply advanced ICD‑10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
Minimum Requirements
BA/BS and a minimum of 5 years’ experience in project/program management, process reengineering, organizational design, or implementation. Equivalent experience is acceptable.
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.
Benefits In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contributions, and more. Salary is based on legitimate, non‑discriminatory factors and may vary by location, experience, and other considerations.
We are an Equal Employment Opportunity employer. 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 expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law. Applicants requiring accommodations for the application process may contact elevancehealthjobssupport@elevancehealth.com.
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