Clinical Provider Auditor II responsible for examining claims and identifying fraud risks at Elevance Health. Collaborating with internal teams and assisting in training new associates.
About the role
- DRG coding Auditor conducting reviews of inpatient medical records for coding accuracy. Ensuring compliance with IPPS methodology and providing guidance to coding staff.
Responsibilities
- Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures.
- Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines, and official coding rules when determining DRG assignment.
- Verify accuracy and specificity of diagnoses, procedures, POA indicators, and discharge disposition, ensuring documentation supports all coding decisions.
- Identify documentation gaps and collaborate with clinical teams to obtain necessary clarifications for accurate code assignment.
- Mentor, coach, and support coding staff, providing guidance on complex DRG and inpatient coding scenarios.
- Deliver feedback and ongoing education to both coders and Clinical Documentation Improvement (CDI) specialists to improve coding quality and documentation completeness.
- Perform routine coding quality audits to assess accuracy, identify trends, and recommend corrective actions.
- Analyze audit findings and prepare detailed reports, highlighting errors, patterns, and opportunities for improvement.
- Stay updated on regulatory changes, payer guidelines, and industry best practices related to IPPS, DRG validation, and inpatient coding.
- Participate in cross-functional meetings with coding, CDI, compliance, and operations teams to strengthen documentation and coding accuracy across the organization
Requirements
- Qualifications: Bachelors in nursing preferable / bachelor’s in science.
- Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder
- Experience: Minimum 2 years’ experience in IP DRG coding or auditing.
- Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE
- Skills and abilities:
- Auditing experience on IP DRG.
- Knowledge in Microsoft outlook/excel/word.
- Exposure on 3M software and NLP tool.
Benefits
- EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Operational Auditor supporting execution of annual audit plan and assessing controls at Western Alliance Bank.
Senior Internal Auditor responsible for risk - based audit assurance activities across multiple Truist locations. Leading interviews and analyzing internal controls to provide recommendations.
Night Auditor managing hotel desk operations overnight. Championing guest service and ensuring hotel readiness for the next day.
As a Part - Time Hotel Night Auditor, responsible for guest service and managing cash transactions at the hotel. Ideal for candidates with prior hotel experience and a passion for hospitality.
Night Auditor providing courteous service and managing daily hotel transactions. Balancing cash and charges, ensuring guest satisfaction, and maintaining financial records.
Senior Auditor providing assurance and insight into governance and risk management practices at SelectQuote. Leading audits and Sarbanes - Oxley compliance for financial reporting risks.
Oversee audit lifecycle and ensure compliance for financial institutions at Fiserv. Collaborating with Staff Auditors and maintaining high audit standards and methodologies.
Auditor for Freight Payment and Audit at Redwood Logistics, processing and auditing carrier invoices efficiently and handling billing inquiries. Collaborating across teams while managing payables in a hybrid work environment.
Inventory Auditor responsible for verifying merchandise and cash in Circle K stores. Conducting physical counts and ensuring compliance with operational standards while working independently in various locations.