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Anthem, Inc. Coding Auditor Sr in Upland, California


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for auditing diagnosis data collected from physician and hospital medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements.

Primary duties may include, but are not limited to:

  • Audits diagnosis data retrieved from physician and hospital medical records and/or data extract files for both revenue project and RADV

  • Assists with National and Targeted Risk Adjustment Data Validation audits.

  • Participates and represents the department in business leadership groups.

  • Serves as a subject matter exert. Assesses and identifies training opportunities.

  • Maintains current knowledge of requirements and guidance required in the performance of audit duties.


  • Requires a high school diploma; 3 years of experience as coder of medical records in physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background.

  • 3 years of experience as provider coding educator; must be comfortable speaking with the providers

  • Experience in creating PowerPoint presentations, knowledge of Excel, Word, etc

  • Willing to travel to provider’s office

  • Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.

  • Experience with ICD -10 required

  • HCC coding experience required

Preferred Qualifications:

  • BS in health sciences, health management or related field preferred.

  • Experience working with Medicare Advantage preferred. Experience with ICD-9 coding a plus. HCC coding preferred.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS55128-California