Elevance Health

DRG Coding Auditor Principal _Virtual: _ _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group...

Long Term Services and Supports Contract Compliance Auditor Location: Candidates must reside in Tennessee. Virtual: This position allows for full-time virtual work, with required in-person training sessions to enhance flexibility and productivity. This model supports work-life balance while ensuring effective onboarding and skill enhancement. As a Long Term Services and Supports Contract Compliance Auditor , you will engage in auditing and compliance activities to uphold the integrity of the Long Term Services and Supports program in accordance with state laws and contractual obligations. Key Responsibilities: Conduct and complete necessary internal and external audits, while overseeing adherence reporting and tracking processes. Audit LTSS operations to guarantee consistent application of contract requirements. Carry out external audits including reviews of enrollee records, new member assessments, short-term stays, MCO transitions, Level of Care...

A healthcare company is seeking a Clinical Provider Auditor II to identify potential risks associated with fraud and abuse in claims. The role requires examining claims for compliance, analyzing medical records, and collaborating with internal units. The ideal candidate will have a minimum of 3 years of medical coding experience and possess relevant certifications. The position offers a hybrid working model with competitive salary and benefits. #J-18808-Ljbffr

Registered Nurse - Diagnosis Related Group Coding Auditor Principal – Carelon Payment Integrity Location: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical records and attending physician’s statements provided by acute care hospitals on paid DRG,...

A leading health company in California is seeking a Clinical Provider Auditor II to identify potential fraud and abuse risks in the healthcare system. This hybrid position requires strong skills in medical coding, with responsibilities including examining claims for compliance and collaborating on internal investigations. Candidates must have a minimum of 3 years of medical auditing experience and relevant coding certifications. Join a workplace that values community health and offers competitive rewards. #J-18808-Ljbffr