Remote Inpatient DRG Auditor – Acute Care

Elevance Health; Indiana; À distance; USD 95 000 - 150 000; Plein temps

Résumé du poste

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims. The role emphasizes ICD-10 coding accuracy, DRG assignment review, and proactive identification of additional recoveries across lines of business.

The position supports virtual full-time work with occasional in-person training; remote work is allowed within policy. Anticipated end date 2026-10-20 and posting end date 08/17/2026.

Qualifications

• Requires AA/AS or minimum 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• RHIA/RHIT/CCS/CIC certifications are accepted.
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsabilités

• 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 auditing concept, valid claim identification and documentation (e.g., letters).
• Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as readmissions, Inpatient to Outpatient, and HACs.
• Suggests and develops high quality, high value concept and/or process improvement and efficiency recommendations.

Connaissances

ICD-10 coding

Auditing

Quality assurance

Clinical review

Formation

AA/AS degree or 5 years claims auditing experience

Description du poste

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims. The role emphasizes ICD-10 coding accuracy, DRG assignment review, and proactive identification of additional recoveries across lines of business.

The position supports virtual full-time work with occasional in-person training; remote work is allowed within policy. Anticipated end date 2026-10-20 and posting end date 08/17/2026.