Remote DRG Clinical Validation Auditor | ICD-10 Expert

Elevance Health, Inc.; Oregon; Hybrid; USD 90,000 - 130,000; Full time

Job summary

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor to audit claims and validate DRG coding accuracy. The position is primarily remote with mandatory in-person training sessions to build competencies.

Ideal candidates hold an RN license, AS/AA degree, and extensive experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG. The role supports our hybrid work model and ongoing professional development.

Qualifications

• Requires AS/AA degree and 8+ years in claims auditing or clinical documentation improvement.
• Requires RN license active and unrestricted in applicable state(s).
• Experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or equivalent background.

Responsibilities

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in audit activities.
• Draws on advanced ICD-10 coding expertise and clinical guidelines to substantiate conclusions.
• Uses audit tools and workflow systems to generate audit determinations and detailed findings letters.
• Maintains accuracy and quality standards established by audit management.
• Identifies documentation and coding errors by recognizing aberrant patterns such as inappropriate billing for readmissions and HACs.
• Suggests and develops high-quality, value-driven process improvements.

Skills

ICD-10 coding

Auditing

Clinical documentation

Healthcare regulations

Education

AS/AA degree

Tools

Audit tools

Chart review systems

Job description

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor to audit claims and validate DRG coding accuracy. The position is primarily remote with mandatory in-person training sessions to build competencies.

Ideal candidates hold an RN license, AS/AA degree, and extensive experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG. The role supports our hybrid work model and ongoing professional development.