Code Edit Disputes Medical Coder
HumanaSalary not specified
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries
Requirements
- AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing
- At least one of the following certifications: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CCS (Certified Coding Specialist), or CIC (Certified Inpatient Coder)
- 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
Responsibilities
- Audit inpatient medical records and generate high quality recoverable claims for all lines of business and clients
- Perform clinical reviews of medical records and documentation to evaluate coding and DRG assignment accuracy, specializing in DRG coding reviews from acute care hospitals
- Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity
- Draw on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
- Utilize audit tools, auditing workflow systems, and reference information to make audit determinations and generate audit findings letters
- Maintain accuracy and quality standards set by audit management for auditing concepts, valid claim identification, and documentation (e.g., letter writing)
- Identify new claim types and potential recoveries outside standard concepts, such as re-admissions, Inpatient to Outpatient transitions, and HACs
- Suggest and develop high quality, high value concept, process improvement, and efficiency recommendations
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this DRG Coding Auditor role fully remote?
This role enables associates to work virtually full-time, with the exception of required in-person training sessions. However, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted.
What certifications are required for the DRG Coding Auditor position?
Requires at least one of the following certifications: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CCS (Certified Coding Specialist), or CIC (Certified Inpatient Coder).
What experience is required for this role?
Requires a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, plus at least one of: AA/AS or 5 years in claims auditing, quality assurance, or recovery auditing.
What is the salary for the DRG Coding Auditor position?
This information is not specified in the job description.
What makes a strong candidate for the DRG Coding Auditor role?
Strong candidates will have the required certifications (RHIA, RHIT, CCS, or CIC), 5+ years with ICD-9/10 and DRG systems, and preferably a BA/BS plus experience in vendor-based DRG coding, clinical validation audits, hospital coding, or quality assurance.
Elevance Health
Integrated health services and digital platform
About Elevance Health
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.
Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees
Benefits
Medical, dental, & vision insurance
401(k) + match
Paid holidays
Paid Time Off
Incentive bonus programs
Stock purchase plan
Life insurance
Wellness Programs
Financial education resources
Adoption & Surrogacy Assistance
Dependent-care Flexible Spending Account (DCFSA)
Parental Leave
Parental Transition Week
Critical Caregiving Leave
Risks
Departure of CFO John Gallina may create a gap in financial leadership.
Lawsuit against CMS over MA Star Ratings could lead to financial penalties.
CareBridge integration may face operational challenges, disrupting service delivery.
Differentiation
Elevance Health integrates whole health approach with digital health platform for comprehensive care.
Acquisition of CareBridge enhances home health services within Carelon division.
Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.
Upsides
AI integration in home health services can reduce hospital readmissions and improve outcomes.
Predictive analytics support early disease detection, aligning with Elevance's whole health approach.
Telehealth expansion offers opportunities to reach more patients remotely.
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