DRG Clinical Validation Auditor | Patient Safety Expert

Elevance Health; Virginia (MN); Hybrid; USD 87,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to review inpatient records and validate DRG coding accuracy. The role supports adherence to clinical documentation guidelines and uses advanced ICD-10 coding to substantiate audit conclusions.

Position allows virtual work with required in-person training and some travel to assigned locations within Minnesota and nearby states. The candidate will lead audits, prepare detailed findings, and recommend quality improvements

Qualifications

• Requires current, active, unrestricted Registered Nurse license in applicable state(s).
• Minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement.
• Minimum of 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audits inpatient medical records to ensure clinical documentation supports DRGs billed and reimbursed.
• Uses ICD-10 coding expertise and clinical guidelines to substantiate audit conclusions.
• Generates audit findings letters and formulates recommendations for process improvements.

Skills

ICD-10 coding

Medical auditing

Clinical guidelines

Education

Registered Nurse license

Tools

Audit software

Job description

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to review inpatient records and validate DRG coding accuracy. The role supports adherence to clinical documentation guidelines and uses advanced ICD-10 coding to substantiate audit conclusions.

Position allows virtual work with required in-person training and some travel to assigned locations within Minnesota and nearby states. The candidate will lead audits, prepare detailed findings, and recommend quality improvements