Manager, DRG Coding – Clinical Validation Audit

Elevance Health

Manager leading DRG Coding & Clinical Validation Audit teams within Elevance Health. Coordination with cross-functional teams to ensure accuracy and compliance in audits for the healthcare industry.

Posted 6/3/2026full-timeIndianapolis • Maryland, New Jersey, New York, Ohio, Texas • 🇺🇸 United StatesMid-LevelSenior💰 $115,020 - $207,216 per yearWebsite

About the role

Key responsibilities & impact

Sets the strategic direction for audit methodologies
Oversees team development
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
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
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

What you’ll need

Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation
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

Comp & perks

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
paid holidays
Paid Time Off
medical, dental, vision, short and long term disability benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10 codingICD-9CMMS-DRGAPR-DRGproject managementprocess reengineeringorganizational designprogram/project reporting toolsaudit methodologiesdata analysis

Soft Skills

team developmentcollaborationcoachingcounselingperformance evaluationcommunicationleadershipstrategic planningproblem-solvingprocess improvement

Certifications

BA/BS degree