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DRG Coding Auditor (Remote)

Company: Elevance Health
Location: Providence
Posted on: November 25, 2022

Job Description:

Responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending physician's statement sent in by acute care hospitals on submitted DRG. Primary duties may include, but are not limited to:

  • Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
  • Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.
  • Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing).
  • Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and HACs.
  • Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations. Requires at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing. Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Cert Coding Specialist and/or CIC as a Certified Inpatient Coder. Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. BA/BS preferred. Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred. For candidates working in person or remotely in the below locations, the salary* range for this specific position is $82,720 to $148,896 Locations: Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithica, NY and Westchester County, NY In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws . * 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 this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Keywords: Elevance Health, Providence , DRG Coding Auditor (Remote), Accounting, Auditing , Providence, Rhode Island

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