DRG Coding Auditor – MS-DRG, APR-DRG

Elevance Health

. Audit inpatient medical records and generate high-quality recoverable claims for the company and its clients .

Posted 11/10/2026full-timeRemote • United StatesMid-LevelSenior💰 $92,880 - $160,218 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Expertise in auditing inpatient medical records and generating recoverable claims, with a strong focus on ICD-10 coding, DRG assignment accuracy, and compliance with clinical guidelines. Proven ability to analyze claims and implement process improvements to enhance efficiency and accuracy in claims auditing.

Highest-signal resume keywords

ICD-10 Coding ExpertiseClaims Auditing ExperienceRHIA/RHIT/CCS/CIC CertificationMS-DRG/AP-DRG/APR-DRG KnowledgeMedical Claims Billing Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AuditingICD-10 CodingDRG AssignmentClinical ReviewAudit Tools UsageMedical Chart Coding PrinciplesQuality AssuranceDocumentation EvaluationProcess ImprovementClaim Identification

Tools & Technologies

Workflow SystemsAudit Tools

Certifications & Qualifications

RHIARHITCCSCICCCDS

Industry Keywords

Medical Claims BillingPayer Reimbursement PoliciesBilling Validation CriteriaProvider Billing GuidelinesClinical Validation Audit

About the role

Key responsibilities & impact

Audit inpatient medical records and generate high-quality recoverable claims for the company and its clients
Perform clinical reviews of medical records and documentation to evaluate coding and DRG assignment accuracy
Review DRG coding using medical records and attending physician statements from acute care hospitals
Analyze and audit claims using medical chart coding principles, clinical guidelines, and objective medical audit practices
Apply advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
Use audit tools, workflow systems, and reference information to make audit determinations and generate audit findings letters
Maintain accuracy and quality standards for auditing concepts, valid claim identification, and documentation
Identify new claim types and potential recoveries, including re-admissions, Inpatient to Outpatient, and HACs
Suggest and develop concept, process improvement, and efficiency recommendations

Requirements

What you’ll need

AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing
At least one certification: RHIA, RHIT, CCS, CIC, or Certified Clinical Documentation Specialist (CCDS)
5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
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
BA/BS preferred
Candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted

Benefits

Comp & perks

$1,500 sign-on bonus
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401(k) contribution and match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work arrangement
Required in-person training sessions
Flexible work-life integration