Remote Inpatient DRG Auditor (Acute Care)

Elevance Health; Crystal Bay (NV); Híbrido; USD 95 000 - 150 000; Tempo integral

Resumo da oferta

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role requires ICD-10/DRG expertise and detailed chart reviews to ensure accurate DRG assignments.

The position supports virtual work with occasional in-person training, and the company notes a comprehensive benefits package and EEO commitment.

Qualificações

• Requires AA/AS or 5 years of experience in claims auditing/QA/recovery auditing.
• Certifications: RHIA, RHIT, CCS or CIC.
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsabilidades

• Analyzes and audits claims by applying medical chart coding principles and clinical guidelines.
• Uses ICD-10 coding expertise to substantiate audit conclusions.
• Uses audit tools and workflow systems to generate audit findings letters.
• Maintains quality standards for auditing concepts, valid claim identification, and documentation.
• Identifies new claim types to unlock additional recoveries (e.g., readmissions, HACs).
• Suggests process improvements and efficiency recommendations.

Conhecimentos

Claims auditing

Quality assurance

Recovery auditing

Formação académica

AA/AS or equivalent

RHIA/RHIT/CCS/CIC certifications

5 years ICD-9/10CM & MS-DRG/AP-DRG/APR-DRG experience

Ferramentas

Audit tools

Auditing workflow systems

Descrição da oferta de emprego

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role requires ICD-10/DRG expertise and detailed chart reviews to ensure accurate DRG assignments.

The position supports virtual work with occasional in-person training, and the company notes a comprehensive benefits package and EEO commitment.