Remote Inpatient DRG Auditor & Validator

ANTHEM INSURANCE COMPANIES INC; Indianapolis (IN); Hybrid; USD 95,000 - 150,000; Full time

Job summary

Elevance Health seeks an Inpatient DRG Validator ( Acute Care ) to audit inpatient medical records and ensure accurate DRG assignments across lines of business. The role emphasizes ICD-10 coding, clinical guidelines, and high-quality lead-generation of recoveries.

The position supports hybrid/virtual work with required in-person training, and candidates may be considered across several eligible locations. A strong background in DRG coding and medical audits is essential.

Qualifications

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

Responsibilities

• Audit inpatient medical records and generate high quality recoverable claims across lines of business.
• Perform clinical reviews to evaluate DRG assignment accuracy with coded data.
• Utilize DRG coding knowledge and audit workflow tools to issue audit findings letters.
• Maintain accuracy per audit management standards and document processes.
• Identify new claim types and opportunities for additional recoveries.

Skills

ICD-10 coding expertise

Clinical guidelines

Auditing/QA

Analytical skills

Education

AA/AS or equivalent

BA/BS preferred

Tools

DRG audit tools

Job description

Elevance Health seeks an Inpatient DRG Validator ( Acute Care ) to audit inpatient medical records and ensure accurate DRG assignments across lines of business. The role emphasizes ICD-10 coding, clinical guidelines, and high-quality lead-generation of recoveries.

The position supports hybrid/virtual work with required in-person training, and candidates may be considered across several eligible locations. A strong background in DRG coding and medical audits is essential.