Remote DRG Clinical Validation Auditor (Patient Safety)

Elevance Health (Anthem); Indianapolis (IN); Remote; USD 87,000 - 130,000; Full time

Job summary

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to audit inpatient records for proper DRG billing. The role emphasizes advanced ICD-10 coding, clinical guidelines, and objective audit practices, with remote work options and in-person training sessions as needed.

Applicants should have a current RN license, 10+ years in related audits, and 5+ years with ICD-9/10CM and DRGs (MS/AP/APR-DRG).

Qualifications

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

Responsibilities

• Audit inpatient medical records to ensure documentation supports DRGs billed and reimbursed.
• Apply ICD-10 coding principles and clinical guidelines to audit conclusions.
• Use audit tools and workflow systems to generate determinations and detailed findings letters.
• Identify documentation and coding errors (e.g., readmissions, inpatient status, HACs).
• Propose high-quality process improvements to enhance efficiency.

Skills

RN license

ICD-10 coding

DRG coding (MS-DRG/AP-DRG/APR-DRG)

Clinical audit experience

Job description

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to audit inpatient records for proper DRG billing. The role emphasizes advanced ICD-10 coding, clinical guidelines, and objective audit practices, with remote work options and in-person training sessions as needed.

Applicants should have a current RN license, 10+ years in related audits, and 5+ years with ICD-9/10CM and DRGs (MS/AP/APR-DRG).