DRG Clinical Auditor Principal

Elevance Health · United States

Elevance Health is seeking a DRG Clinical Auditor Principal to lead complex DRG and clinical audits that support accurate, compliant reimbursement across our national health plans. In this senior role, you will perform in-depth inpatient medical record reviews, validate DRG assignments, and assess documentation quality using ICD-10-CM/PCS and industry guidelines. You will identify and document variances, prepare clear audit findings, and partner with coders, clinicians, and medical directors to resolve complex cases. Leveraging your expertise, you will mentor other auditors, contribute to audit methodologies, and analyze trends to drive process improvements, mitigate financial and compliance risk, and support Elevance Health’s mission to simplify healthcare and improve whole-person outcomes.