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Elevance Health · 1 day ago

DRG Coding Auditor

Houston, TX

Full-time

Hybrid

Mid, Senior Level

$95K/yr - $150K/yr

5+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims, while performing clinical reviews to evaluate coding and DRG assignment accuracy.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

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

Qualification

ICD-10 coding expertiseDRG codingClaims auditingRHIA certificationRHIT certificationCCS certificationCIC certificationICD-9/10CM experienceQuality assuranceMedical claims knowledgeSoft skills

Required

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 Certified 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

Preferred

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

Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)