Remote Inpatient DRG Auditor (Acute Care)

Elevance Health; Nevada; Híbrido; USD 95.000 - 150.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid work environment

Competitive salary

Descripción de la vacante

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high quality recoverable claims. The role requires ICD-9/10CM, MS-DRG, AP-DRG expertise and relevant certifications. Remote work option with occasional in-person training is available.

Expect collaboration across lines of business and ongoing process improvements. Anticipated end date is 2026-10-20. The position supports a hybrid work model with location flexibility, subject to commuting

Formación

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

Responsabilidades

• Analyzes and audits claims using coding principles and clinical guidelines.
• Uses ICD-10 expertise to substantiate conclusions.
• Uses audit tools and workflows to make determinations and generate audit letters.
• Maintains quality standards for auditing concepts and documentation.
• Identifies new claim opportunities for recoveries (e.g., readmissions, HACs).
• Proposes high-quality process improvements.

Conocimientos

Claims auditing

Quality assurance

ICD-10 coding

Educación

AA/AS or 5+ years in claims auditing

Herramientas

Auditing software

Descripción del empleo

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high quality recoverable claims. The role requires ICD-9/10CM, MS-DRG, AP-DRG expertise and relevant certifications. Remote work option with occasional in-person training is available.

Expect collaboration across lines of business and ongoing process improvements. Anticipated end date is 2026-10-20. The position supports a hybrid work model with location flexibility, subject to commuting