Remote Inpatient DRG Auditor & Coding Validation Specialist

Elevance Health; Indianapolis (IN); À distance; USD 95 000 - 150 000; Plein temps

Résumé du poste

Elevance Health is seeking an Inpatient DRG Validator to audit inpatient medical records and generate high quality recoverable claims across lines of business. The role includes clinical reviews of documentation to ensure accurate DRG assignments and coding integrity.

The position requires 5+ years of ICD-9/10CM and DRG experience, RHIA/RHIT/CCS/CIC certifications, and a background in hospital coding or QA. Remote work with in-person training is supported and some locations may apply.

Qualifications

• AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder.
• Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsabilités

• 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.

Connaissances

ICD-10 coding expertise

Quality auditing

Clinical guidelines

Auditing

Formation

BA/BS preferred

Outils

Audit tools

Description du poste

Elevance Health is seeking an Inpatient DRG Validator to audit inpatient medical records and generate high quality recoverable claims across lines of business. The role includes clinical reviews of documentation to ensure accurate DRG assignments and coding integrity.

The position requires 5+ years of ICD-9/10CM and DRG experience, RHIA/RHIT/CCS/CIC certifications, and a background in hospital coding or QA. Remote work with in-person training is supported and some locations may apply.