Remote Inpatient DRG Auditor - Acute Care

Elevance Health; Tennessee; Ibrido; USD 95.000 - 150.000; Tempo pieno

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

ICD-10 coding

Medical record auditing

Clinical review

Formazione

AA/AS degree

Strumenti

DRG Coding systems

Audit workflow tools

Descrizione del lavoro

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.