Remote DRG Validation Auditor - RN, CDI Expert

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

Benefits offered by this job

Comprehensive benefits package

401(k) plan

Stock purchase plan

Job summary

Elevance Health seeks a DRG Clinical Validation Auditor - RN to audit inpatient records, ensuring documentation supports DRGs billed and reimbursed. The role emphasizes ICD-10 coding accuracy and application of clinical guidelines within a hybrid/virtual, primarily remote work model.

Required is a valid RN license and 10+ years in claims auditing or CDI, with 5+ years in ICD-9/10CM and DRG systems. The position offers comprehensive benefits and opportunities for professional impact.

Qualifications

• Requires active RN license in applicable state(s).
• Minimum 10 years in claims auditing, QA, or clinical documentation improvement.
• Minimum 5 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or equivalent background.

Responsibilities

• Audit inpatient medical records to ensure clinical documentation supports DRGs billed.
• Use ICD-10 coding expertise and clinical guidelines to substantiate conclusions.
• Generate audit determinations and detailed audit findings letters.
• Identify potential documentation and coding errors such as readmissions or HACs.
• Suggest high quality process improvement recommendations.

Skills

ICD-10 coding

Clinical guidelines

Auditing

Medical chart review

Education

Registered Nurse (RN) license

Tools

Audit tools

Auditing workflow systems

Job description

Elevance Health seeks a DRG Clinical Validation Auditor - RN to audit inpatient records, ensuring documentation supports DRGs billed and reimbursed. The role emphasizes ICD-10 coding accuracy and application of clinical guidelines within a hybrid/virtual, primarily remote work model.

Required is a valid RN license and 10+ years in claims auditing or CDI, with 5+ years in ICD-9/10CM and DRG systems. The position offers comprehensive benefits and opportunities for professional impact.