DRG Clinical Validation Auditor — ICD-10 Expert

Elevance Health; United States; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is seeking a DRG Clinical Validation Auditor to audit inpatient records and ensure documentation supports DRGs billed. The role emphasizes ICD-10 coding proficiency, DRG expertise, and evidence-based audit conclusions in a fast-paced environment.

The candidate will work within Elevance Health's hybrid workforce, engaging in training sessions in-person and occasional on-site activities as needed. An RN license and extensive claims auditing experience are required.

Qualifications

• 8+ years of claims auditing, QA, or clinical documentation improvement experience.
• Proficiency with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• Active RN license in applicable state(s).

Responsibilities

• Audit inpatient medical records to verify that clinical documentation supports DRGs billed and reimbursed.
• Apply ICD-10 coding principles and clinical guidelines to substantiate audit conclusions.
• Generate detailed audit findings letters and support decision-making with evidence-based reasoning.
• Identify documentation and coding gaps and suggest process improvements for higher accuracy.
• Collaborate with audit tools and systems to maintain quality standards.

Skills

ICD-10 coding

DRG coding

Auditing & QA

Medical chart review

Education

AS/AA degree

RN license

Tools

Audit tools & workflow systems

Job description

Elevance Health is seeking a DRG Clinical Validation Auditor to audit inpatient records and ensure documentation supports DRGs billed. The role emphasizes ICD-10 coding proficiency, DRG expertise, and evidence-based audit conclusions in a fast-paced environment.

The candidate will work within Elevance Health's hybrid workforce, engaging in training sessions in-person and occasional on-site activities as needed. An RN license and extensive claims auditing experience are required.