Remote Inpatient DRG Validator, Acute Care

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

Job summary

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high quality recoverable claims across lines of business. The role requires advanced ICD-10 coding knowledge and experience in DRG/audit settings. Hybrid/virtual work is available with some in-person training and location flexibility.

Salary ranges are provided for multiple locations in the US. The role emphasizes clinical record reviews, DRG assignment accuracy, and recommendations for

Qualifications

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

Responsibilities

• Audits inpatient medical records and generates high quality recoverable claims.
• Performs clinical reviews of medical records to evaluate coding accuracy.
• Uses audit tools and workflow systems to make audit determinations and issue findings letters.
• Maintains accuracy and quality standards for auditing concepts, valid claims, and documentation.

Skills

ICD-10 coding expertise

Claims auditing

Quality assurance

Clinical review

Education

RHIA certification

RHIT certification

CCS certification

CIC certification

Tools

Audit tools

Medical record review systems

Job description

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high quality recoverable claims across lines of business. The role requires advanced ICD-10 coding knowledge and experience in DRG/audit settings. Hybrid/virtual work is available with some in-person training and location flexibility.

Salary ranges are provided for multiple locations in the US. The role emphasizes clinical record reviews, DRG assignment accuracy, and recommendations for