Remote Inpatient DRG Auditor – Acute Care

Elevance Health; Athens (GA); Hybrid; USD 95,000 - 150,000; Full time

Job summary

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims for all lines of business. The role emphasizes ICD-10 coding accuracy, DRG assignments, and clinical validation to support compliant reimbursements.

The position offers a hybrid/virtual work arrangement with occasional in-person sessions and remote options. Applicants should have 5+ years in claims auditing and relevant certifications.

Qualifications

• Requires at least AA/AS or 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• Requires RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder.
• Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters.
• Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing).
• Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and HACs.
• Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.

Skills

ICD-10 coding

Claims auditing

Clinical guidelines

Auditing tools

DRG knowledge

Education

AA/AS or equivalent

Tools

Audit software

Coding/claim systems

Job description

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims for all lines of business. The role emphasizes ICD-10 coding accuracy, DRG assignments, and clinical validation to support compliant reimbursements.

The position offers a hybrid/virtual work arrangement with occasional in-person sessions and remote options. Applicants should have 5+ years in claims auditing and relevant certifications.