DRG Clinical Auditor Principal

Job overview

The DRG Clinical Auditor Principal is a virtual role based in Mason, OH. Compensation is not specified for this position, which supports the clinical audit department at Elevance Health. This role exists to audit inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology. The auditor generates complex findings for recoverable claims and specializes in reviewing DRG coding via medical records and physician statements for acute care hospitals.

What you'll do

• Analyze and audit claims by integrating advanced medical chart coding principles.
• Utilize audit tools and workflow systems to make determinations and generate findings.
• Validate accuracy and quality standards for lower-level auditors.
• Identify new claim types for potential recoveries.
• Collaborate with management to improve selection criteria.

What we're looking for

Skills & competencies

full-time

virtual

mason oh

clinical auditor

drg

icd-10

medical coding

claims auditing

healthcare

elevance health

Work arrangement

• Weekend coverage required

Benefits & perks

• Virtual work flexibility, professional development, comprehensive benefits.

Why this role

Virtual work arrangement, high level of autonomy, focus on complex DRG coding validation.

About the employer

Elevance Health is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.