Remote Inpatient DRG Auditor (Acute Care)

Elevance Health; East Windsor Hill (CT); Hybrid; USD 95,000 - 150,000; Full time

Job summary

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high-quality recoverable claims across lines of business. You will perform clinical reviews to assess DRG coding accuracy, focusing on inpatient DRG validation for acute care hospitals.

Role emphasizes advanced ICD-10 coding, adherence to guidelines, and producing audit findings letters. Hybrid/virtual work with in-person onboarding and training commitments may apply.

Qualifications

• AA/AS degree or equivalent requested.
• Requires 5 years of experience in claims auditing, QA, or recovery auditing.

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

Claims auditing experience

ICD-9/10CM

MS-DRG

AP-DRG/APR-DRG

Education

AA/AS

5+ years claims auditing experience

Tools

RHIA/RHIT/CCS/CIC certifications

Job description

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high-quality recoverable claims across lines of business. You will perform clinical reviews to assess DRG coding accuracy, focusing on inpatient DRG validation for acute care hospitals.

Role emphasizes advanced ICD-10 coding, adherence to guidelines, and producing audit findings letters. Hybrid/virtual work with in-person onboarding and training commitments may apply.