Remote DRG Clinical Validation Auditor

Elevance Health, Inc.; Grand Prairie (TX); Remoto; USD 90.000 - 130.000; Tempo pieno

Descrizione del lavoro

Elevance Health, Inc. is seeking a Diagnosis Related Group Clinical Validation Auditor to review inpatient records and ensure clinical documentation supports DRG coding and reimbursement.

You will apply ICD-10 coding expertise and guidelines to substantiate findings. The role is remotely based with mandatory in-person training sessions; applicants outside commuting distance may be considered with accommodation.

Competenze

• Requires an AS/AA degree and a minimum of 8 years of experience in claims auditing, quality assurance, or clinical documentation improvement.
• Requires current, active, valid and unrestricted Registered Nurse license in applicable state(s).
• Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG or equivalent background.

Mansioni

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
• Maintains accuracy and quality standards as established by audit management.
• Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
• Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.

Conoscenze

ICD-10 coding

Medical auditing

Clinical documentation

RN license

Formazione

AS/AA degree

Descrizione del lavoro

Elevance Health, Inc. is seeking a Diagnosis Related Group Clinical Validation Auditor to review inpatient records and ensure clinical documentation supports DRG coding and reimbursement.

You will apply ICD-10 coding expertise and guidelines to substantiate findings. The role is remotely based with mandatory in-person training sessions; applicants outside commuting distance may be considered with accommodation.