Elevance Health este o companie de servicii medicale și asigurări de sănătate care dezvoltă o abordare mai amplă și pe termen lung pentru sprijinirea sănătății oamenilor. Activitatea sa combină beneficiile medicale, serviciile integrate pentru sănătatea întregii persoane și capacitățile de sănătate digitală, concepute pentru a conecta mai eficient îngrijirea medicală cu acoperirea de asigurare. Cu o echipă de aproape 100.000 de angajați care deservește peste 118 milioane de persoane, Elevance Health oferă roluri într-o organizație mare și multidisciplinară, concentrată pe îmbunătățirea rezultatelor în materie de sănătate, evoluția sistemului de sănătate și sprijinirea unor comunități mai puternice.
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.
Descriere
- 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.
Cerințe
- 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.
Beneficii
- 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.