Remote DRG Clinical Validation Auditor (RN)

Elevance Health; Seattle (WA); Hybrid; USD 87,000 - 156,000; Full time

Job summary

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor - RN (CDI, MS-DRG, AP-DRG & APR-DRG) to audit inpatient records and ensure clinical documentation supports DRGs billed and reimbursed.

The role requires an active RN license, 10+ years in claims auditing or clinical documentation improvement, and 5+ years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. Hybrid/remote work options are available, with in-person onboarding and training sessions.

Qualifications

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

Responsibilities

• Audit inpatient medical records to verify DRG billing accuracy.
• Substantiate audit conclusions with ICD-10 coding and clinical guidelines.
• Generate detailed audit findings letters and maintain quality standards.

Skills

ICD-10 coding expertise

Clinical guidelines

Auditing workflow systems

Tools

Audit tools

Job description

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor - RN (CDI, MS-DRG, AP-DRG & APR-DRG) to audit inpatient records and ensure clinical documentation supports DRGs billed and reimbursed.

The role requires an active RN license, 10+ years in claims auditing or clinical documentation improvement, and 5+ years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. Hybrid/remote work options are available, with in-person onboarding and training sessions.