Remote Inpatient DRG Auditor - Acute Care

Elevance Health; Tennessee; Hybrid; USD 95,000 - 150,000; Full time

Job summary

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records, validate DRG assignments, and generate high-quality recoverable claims across lines of business. The role emphasizes ICD-10 coding expertise and clinical review of documentation from acute care hospitals.

The candidate will work in a hybrid/virtual model with preferred on-site engagement as required. 5 years of DRG/coding experience and relevant certifications are highly valued.

Qualifications

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

Responsibilities

• Audits inpatient medical records to generate high quality recoverable claims.
• Reviews medical records for accurate DRG assignment and coding.
• Utilizes audit tools and workflows to support audit determinations and letters.
• Identifies potential new claim types for additional recoveries.
• Develops process improvements and efficiency recommendations.

Skills

ICD-10 coding

Medical record auditing

Clinical review

Education

AA/AS degree

Tools

DRG Coding systems

Audit workflow tools

Job description

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records, validate DRG assignments, and generate high-quality recoverable claims across lines of business. The role emphasizes ICD-10 coding expertise and clinical review of documentation from acute care hospitals.

The candidate will work in a hybrid/virtual model with preferred on-site engagement as required. 5 years of DRG/coding experience and relevant certifications are highly valued.