Elevance Health

Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. 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 accommodation is granted as required by law. The Patient Safety 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...

Patient Safety DRG Coding Auditor Principal Location: This role enables associates to work virtually full-time, except for 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 if candidates reside within a commuting distance from an office. The Patient Safety 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 record and attending physician's statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG,...

The AI Audit Analyst is responsible for conducting risk assessments, reviews, special projects, and other activities on Artificial Intelligence (AI) solutions for the enterprise, across all lines of business and functions, to ensure Elevance Health develops and deploys AI technologies consistent with our internal standards, policies, contracts, laws, and regulations. This position is an exciting opportunity to provide valuable insights to the AI business to improve the effectiveness of risk management, monitoring, and governance processes. How you will make an impact: Assists the development and execution of high-quality risk assessments of AI solutions. Perform reviews of AI solutions, testing for compliance to Elevance Health standards, policies, and regulations. Identify risks and collaborate with AI system team leadership and business management on testing and evaluation procedures, which includes working with the AI business on process, controls, documentation, and...

Elevance Health is looking for an AI Audit Analyst in Chicago, Illinois, responsible for conducting risk assessments and reviews of AI solutions across all business lines. This role involves ensuring compliance with standards while offering insights to improve risk management processes. The ideal candidate will have an AA/AS degree in Information Technology or related fields along with at least 4 years of audit experience. Certification such as CISA or CPA is preferred. This position supports a hybrid work model that requires being onsite regularly. #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,...