Remote Inpatient DRG Validator – Acute Care

Elevance Health; Lorida (FL); Hybrid; USD 95,000 - 150,000; Full time

Job summary

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims for all lines of business and clients.

The role requires advanced ICD-10/DRG knowledge and auditing experience, with hybrid/virtual work options and mandatory in-person training as needed. Flexible locations across the posting are supported.

Qualifications

• Requires at least one of AA/AS or 5 years of claims auditing experience.
• Requires certifications RHIA, RHIT, CCS or CIC.
• 5 years experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Analyzes and 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.

Skills

ICD-9/10CM & MS-DRG experience

AP-DRG & APR-DRG experience

RHIA/RHIT/CCS/CIC certifications

Education

AA/AS

Job description

Elevance Health is seeking an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims for all lines of business and clients.

The role requires advanced ICD-10/DRG knowledge and auditing experience, with hybrid/virtual work options and mandatory in-person training as needed. Flexible locations across the posting are supported.