Remote Inpatient DRG Validator (Acute Care)

Elevance Health (Anthem); Indianapolis (IN); Ibrido; USD 95.000 - 150.000; Tempo pieno

Descrizione del lavoro

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit claims using ICD-10 coding principles and DRG guidelines. This virtual, full-time role supports in-person training and may consider alternate locations. The position emphasizes accuracy, audit letters, and quality standards in a HIPAA-compliant environment.

You will analyze claims, substantiate conclusions with clinical guidelines, identify new DRG opportunities, and recommend process improvements to maximize value.

Competenze

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

Mansioni

• Audits and analyzes claims using medical chart coding principles and clinical guidelines.
• Draws on ICD-10 coding expertise to substantiate conclusions and generate audit findings letters.
• Uses audit tools and workflows to make audit determinations and document outcomes.
• Maintains accuracy and quality standards for auditing concepts, valid claim identification, and documentation.
• Identifies new claim types and opportunities for additional recoveries (e.g., readmissions, HACs) and suggests improvements.

Conoscenze

ICD-10 coding

DRG auditing

Claims auditing

Quality assurance

Audit tools

Formazione

AA/AS or 5+ years experience

BA/BS preferred

Strumenti

DRG coding software

Descrizione del lavoro

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit claims using ICD-10 coding principles and DRG guidelines. This virtual, full-time role supports in-person training and may consider alternate locations. The position emphasizes accuracy, audit letters, and quality standards in a HIPAA-compliant environment.

You will analyze claims, substantiate conclusions with clinical guidelines, identify new DRG opportunities, and recommend process improvements to maximize value.