Remote Inpatient DRG Clinical Validation Auditor

Elevance Health, Inc.; United States; Hybrid; USD 87,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

401(k) contribution

Incentive programs

Job summary

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to audit inpatient medical records and ensure clinical documentation supports billed DRGs. The role emphasizes ICD-10 coding expertise and DRG accuracy across hospital claims.

You will review charts, generate detailed audit findings, and collaborate with clinical staff. A current, unrestricted RN license and extensive claims auditing experience are required; hybrid/virtual work options apply with some in-person training.

Qualifications

• Active, unrestricted RN license in applicable state(s).
• 10+ years in claims auditing, QA, or clinical documentation improvement.
• 5+ years with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG.

Responsibilities

• Audit inpatient records to ensure DRG accuracy and documentation alignment.
• Apply ICD-10 coding expertise to support audit conclusions.
• Generate detailed audit findings letters and use audit tools/workflow systems.
• Identify documentation/coding errors such as readmission billing, inpatient status, HACs.
• Suggest high-quality process improvement and efficiency recommendations.

Skills

Registered Nurse license

ICD-10/ICD-9CM experience

DRG auditing

Claims auditing

Clinical guidelines knowledge

Tools

ICD-10 coding tools

Job description

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to audit inpatient medical records and ensure clinical documentation supports billed DRGs. The role emphasizes ICD-10 coding expertise and DRG accuracy across hospital claims.

You will review charts, generate detailed audit findings, and collaborate with clinical staff. A current, unrestricted RN license and extensive claims auditing experience are required; hybrid/virtual work options apply with some in-person training.