Apply on Employer Site

Elevance Health · 12 hours ago

Managers of DRG Coding & Clinical Validation Audit

Washington, DC

Full-time

Hybrid

Mid, Senior Level

$111K/yr - $200K/yr

5+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Managers of DRG Coding & Clinical Validation lead a high-performing team responsible for auditing inpatient medical records to ensure the accuracy and compliance of Diagnosis-Related Group (DRG) assignments, identifying coding discrepancies, and supporting regulatory integrity.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

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

Analysis of audit trends, DRG shifts, and using 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

Responsible for championing local stakeholders and tactical decision-makers

Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations

Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions

Qualification

DRG auditingICD-10 codingProject managementInpatient codingProcess reengineeringOrganizational designPerformance evaluationData analysisTeam leadershipCross-functional collaboration

Required

Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or any combination of education and experience, which would provide an equivalent background

Travels to worksite and other locations as necessary

Preferred

Preferred experience includes a 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 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

Represents job field similar to this job

Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)