Remote Inpatient DRG Validator (Acute Care)

Elevance Health; Maryland City (MD); Hybrid; USD 95.000 - 150.000; Vollzeit

Zusammenfassung

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient records, validate DRG assignments, and generate high-quality recoverable claims across lines of business. You will review medical records with ICD-10 coding precision, produce audit letters, and support process improvements.

The role requires extensive claims auditing and DRG coding expertise, with remote work options and mandatory in-person training sessions.

Qualifikationen

• AA/AS or 5 years of claims auditing experience.
• RHIA/RHIT/CCS/CIC certification options.
• 5 years of ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG experience.

Aufgaben

• Analyzes and audits claims by applying coding principles and guidelines.
• Uses ICD-10 knowledge to substantiate audit conclusions.
• Utilizes audit tools and workflow systems to generate findings letters.
• Maintains quality standards for audit concepts and documentation.
• Identifies new claim types with potential for additional recoveries.
• Proposes high-value process improvements.

Kenntnisse

Claims auditing

ICD-10 coding

DRG coding

Ausbildung

AA/AS or equivalent

BA/BS preferred

Jobbeschreibung

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient records, validate DRG assignments, and generate high-quality recoverable claims across lines of business. You will review medical records with ICD-10 coding precision, produce audit letters, and support process improvements.

The role requires extensive claims auditing and DRG coding expertise, with remote work options and mandatory in-person training sessions.