Remote Inpatient DRG Validator (Acute Care)

Elevance Health; Maryland; Remote; USD 95,000 - 150,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

Elevance Health seeks an Inpatient DRG Validator to audit inpatient medical records and ensure accurate DRG coding across lines of business. The role emphasizes clinical reviews, ICD-10 coding expertise, and high-quality recoverable claims.

The position supports a virtual full-time work model with required in-person training, with alternate locations considered. Minimum experience includes 5 years in claims auditing and relevant certifications.

Qualifications

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

Responsibilities

• Audits inpatient medical records and generates high quality recoverable claims across lines of business.
• Performs clinical reviews to evaluate DRG coding accuracy.
• Uses ICD-10 coding and clinical guidelines to substantiate audit conclusions.
• Identifies potential new claim types for additional recoveries (e.g., readmissions, HACs).
• Proposes process improvements to raise audit quality and efficiency.

Education

BA/BS preferred

5 years claims auditing

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

RHIA

RHIT

CCS

CIC

Tools

Audit tools

Auditing workflow systems

Job description

Elevance Health seeks an Inpatient DRG Validator to audit inpatient medical records and ensure accurate DRG coding across lines of business. The role emphasizes clinical reviews, ICD-10 coding expertise, and high-quality recoverable claims.

The position supports a virtual full-time work model with required in-person training, with alternate locations considered. Minimum experience includes 5 years in claims auditing and relevant certifications.