Elevance Health एक स्वास्थ्य सेवा और स्वास्थ्य बीमा कंपनी है, जो लोगों के स्वास्थ्य को सहयोग देने के लिए व्यापक और दीर्घकालिक दृष्टिकोण विकसित कर रही है। इसका काम स्वास्थ्य लाभों, समेकित समग्र-स्वास्थ्य सेवाओं और डिजिटल स्वास्थ्य क्षमताओं को जोड़ता है, ताकि देखभाल और कवरेज को अधिक प्रभावी ढंग से एक-दूसरे से जोड़ा जा सके। लगभग 100,000 कर्मचारियों के साथ 11.8 करोड़ से अधिक लोगों की सेवा करते हुए, Elevance Health एक बड़े, बहुविषयक संगठन में अवसर प्रदान करती है, जिसका उद्देश्य स्वास्थ्य परिणामों में सुधार करना, स्वास्थ्य सेवा प्रणाली को विकसित करना और अधिक सशक्त समुदायों का समर्थन करना है।
DRG Coding Audit Manager | Elevance Health
Lead inpatient DRG coding audits and compliance at Elevance Health, guiding audit strategy, team development, reporting, and recoverable claim identification.
विवरण
- Lead a team auditing inpatient medical records for DRG assignment accuracy and compliance.
- Find coding discrepancies and claims eligible for recovery.
- Set the strategic direction for audit methods.
- Develop the team and ensure audits follow industry practices and payer requirements.
- Partner with clinical, compliance, provider engagement, and data analytics teams.
- Hire, train, coach, counsel, and evaluate direct reports.
- Use audit trends, DRG shifts, and financial results to guide strategy.
- Define program and project scope and design.
- Create metrics and reporting tools for programs and projects.
- Assess variance against program and project plans.
- Lead documentation that supports business goals and consistent practices.
- Represent local stakeholders and tactical decision-makers.
- Recommend process improvements and efficiency gains.
- Apply advanced ICD-10 coding knowledge, clinical guidelines, and industry expertise to support audit conclusions.
आवश्यकताएँ
- Bachelor’s degree required.
- At least five years of experience in project or program management, process reengineering, organizational design, or implementation, or an equivalent combination of education and experience.
- Live within a reasonable commuting distance of a designated posting location in Virginia, Indiana, Georgia, Ohio, Maryland, New Jersey, New York, or Texas.
- Inpatient coding or DRG auditing experience preferred, including 2–3 years in a leadership or supervisory role.
- Experience with ICD-9/10-CM, MS-DRG, and APR-DRG.
- Broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, billing validation criteria, and coding terminology preferred.
- Travel to the worksite and other locations as needed.
लाभ
- Comprehensive benefits package.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid time off.
- Incentive bonus programs.
- Medical benefits.
- Dental benefits.
- Vision benefits.
- Short-term disability benefits.
- Long-term disability benefits.
- 401(k) with company match.
- Stock purchase plan.
- Life insurance.
- Wellness programs.
- Financial education resources.
- Hybrid work flexibility.