Remote DRG Clinical Validation Auditor - RN-CDI Expert

Elevance Health; Mendota Heights (MN); Hybrid; USD 87,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) + matching

Equity stock purchase plan

Job summary

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor - RN to audit inpatient records and ensure documentation supports DRG billing. The role emphasizes ICD-10 coding, clinical guidelines, and high-quality audit outcomes.

Both virtual and hybrid work arrangements are available, with in-person training as needed. The ideal candidate will have a strong RN license, extensive claims auditing experience, and CDI expertise to drive accuracy and reimbursement integrity across

Qualifications

• Requires active RN license in applicable state(s).
• Minimum 10 years in claims auditing, QA, or clinical documentation improvement.
• Minimum 5 years working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• Preferred: RHIT, RHIA, CCDS, CDIP, CPC or inpatient coding credentials such as CCS/CIC.

Responsibilities

• Analyzes and audits claims by integrating medical chart coding principles, guidelines, and objective audit practices.
• Draws on advanced ICD-10 coding expertise and clinical guidelines to substantiate conclusions.
• Uses audit tools and workflow systems to generate determinations and detailed findings letters.
• Maintains accuracy and quality per audit management standards.
• Identifies coding/documentation errors and unusual patterns, including readmissions, admission status, HACs.

Skills

ICD-10 coding

Medical auditing

Quality assurance

Medical record review

Regulatory guidelines

Education

Registered Nurse license

Job description

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor - RN to audit inpatient records and ensure documentation supports DRG billing. The role emphasizes ICD-10 coding, clinical guidelines, and high-quality audit outcomes.

Both virtual and hybrid work arrangements are available, with in-person training as needed. The ideal candidate will have a strong RN license, extensive claims auditing experience, and CDI expertise to drive accuracy and reimbursement integrity across