Locations: IL-CHICAGO, 233 S WACKER DR, STE 3700; WI-Waukesha, N17W24222 Riverwood Dr., Ste 300; MO-ST LOUIS, 1831 CHESTNUT ST; CT-WALLINGFORD, 108 LEIGUS RD; MD-HANOVER, 7550 TEAGUE RD, STE 500
Time type: Full time
Posted on: Posted 3 Days Ago
Application deadline: End Date: August 22, 2025 (27 days left to apply)
Job requisition ID: JR159945
Anticipated End Date: 2025-08-22
Position Title: DRG Coding Auditor
Job Description:
DRG Coding Auditor
This role enables associates to work virtually full-time, with required in-person training sessions, providing flexibility and autonomy. Candidates outside a reasonable commuting distance will not be considered unless an accommodation is granted.
Carelon Payment Integrity, part of Elevance Health, focuses on recovering and preventing unnecessary medical expenses.
The DRG Coding Auditor audits inpatient medical records and generates high-quality recoverable claims, performs clinical reviews of medical records, and specializes in DRG coding review based on medical records and physician statements.
Impact:
- Analyzes and audits claims using coding principles, clinical guidelines, and objectivity.
- Uses ICD-10 coding expertise and industry knowledge to support conclusions.
- Utilizes audit tools and systems to make determinations and communicate findings.
- Maintains accuracy and quality standards.
- Identifies new claim types for potential recoveries.
- Suggests process improvements.
Minimum Requirements:
- At least one of the following: AA/AS or 5+ years in claims auditing, QA, or recovery auditing.
- Certifications: RHIA, RHIT, CCS, or CIC.
- 5 years experience with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG.
Preferred Skills:
- BA/BS preferred.
- Experience with vendor DRG coding or hospital coding preferred.
- Knowledge of billing/payment systems, reimbursement policies, and coding terminology.
Salary range: $95,172 to $149,556, depending on location and experience.
Locations: Colorado, Illinois, Maryland, Minnesota, Nevada
Benefits include comprehensive packages, incentives, stock purchase, 401k, and more.
Work arrangement: Hybrid, with at least weekly onsite requirement unless specified otherwise.
Vaccination policy: Required for certain roles, in accordance with laws.
Equal Opportunity Employer: Consideration without regard to protected categories.
Application deadlines vary: July 31, August 21, August 31, 2025.
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