Remote DRG Clinical Validation Auditor

Elevance Health, Inc.; Miami (FL); Remoto; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Elevance Health is seeking a DRG Clinical Validation Auditor to audit inpatient medical records and ensure documentation supports DRGs billed and reimbursed. This role specializes in DRG paid claims and requires advanced ICD-10 coding expertise.

The candidate will analyze claims, apply clinical guidelines, and generate detailed audit findings letters, driving improvements in documentation and coding accuracy across the organization.

Competenze

• Requires an AS/AA degree and RN license.

Mansioni

• Audits inpatient medical records to ensure clinical documentation supports DRGs billed and reimbursed.
• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objective audit methods.
• Utilizes ICD-10 coding expertise and guideline knowledge to substantiate audit conclusions.
• Generates detailed audit findings letters and identifies coding/documentation gaps.
• Suggests process improvements to enhance documentation quality and coding accuracy.

Descrizione del lavoro

Elevance Health is seeking a DRG Clinical Validation Auditor to audit inpatient medical records and ensure documentation supports DRGs billed and reimbursed. This role specializes in DRG paid claims and requires advanced ICD-10 coding expertise.

The candidate will analyze claims, apply clinical guidelines, and generate detailed audit findings letters, driving improvements in documentation and coding accuracy across the organization.