Elevance Health ir veselības aprūpes un veselības apdrošināšanas uzņēmums, kas veido plašāku un ilgtermiņa pieeju cilvēku veselības atbalstam. Uzņēmuma darbība apvieno veselības pabalstus, integrētus visaptverošas veselības aprūpes pakalpojumus un digitālās veselības iespējas, lai efektīvāk sasaistītu aprūpi un apdrošināšanas segumu. Ar gandrīz 100 000 darbinieku un vairāk nekā 118 miljoniem apkalpotu cilvēku Elevance Health piedāvā amatus lielā, daudznozaru organizācijā, kas koncentrējas uz veselības rezultātu uzlabošanu, veselības aprūpes sistēmas attīstību un stiprāku kopienu atbalstīšanu.
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.
Apraksts
- 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.
Prasības
- 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.
Priekšrocības
- 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.