Hybrid Manager, DRG Coding – Clinical Validation Audit

at Elevance Health

• Job title: Manager, DRG Coding – Clinical Validation Audit
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $111,040 - $199,872 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Indianapolis, United States

About the role

• Managers of DRG Coding overseeing auditing of inpatient medical records at Elevance Health. Collaborating with clinical and data teams to ensure accuracy and compliance under industry standards.

Responsibilities

• Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry’s best practices and payer-specific requirements.
• Collaborates cross-functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Analysis of audit trends, DRG shifts, and using financial outcomes to inform strategy.
• Plans program/project scope and design.
• Develops metrics and program/project reporting tools.
• Analyzes variance to program/project plan.
• Leads building of documentation to support business objectives and ensure consistency.
• Responsible for championing local stakeholders and tactical decision-makers.
• Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.

Requirements

• Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or any combination of education and experience, which would provide an equivalent background.
• Preferred experience includes a minimum of 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity.
• Experience working with ICD-9/10CM, MS-DRG and APR-DRG.
• Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• bonuses
• medical, dental, vision
• short and long term disability benefits
• stock purchase plan
• life insurance
• wellness programs
• financial education resources