Remote Inpatient DRG Validator (Acute Care)

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

Job summary

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high-quality recoverable claims across all lines of business. The role emphasizes ICD-10 coding accuracy and DRG assignments based on medical records and physician statements from acute care hospitals.

Candidates should have 5+ years in claims auditing or related fields and relevant certifications such as RHIA/RHIT/CCS/CIC.

Qualifications

• Requires AA/AS or minimum 5 years of experience in claims auditing, quality assurance, or recovery auditing.
• RHIA/RHIT/CCS/CIC certifications are preferred (certifications listed).
• 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.
• Performs clinical reviews to evaluate coding and DRG assignment accuracy.
• Uses audit tools and workflow systems to make audit determinations and draft findings letters.
• Maintains accuracy and quality standards for audit concepts, valid claim identification, and documentation.
• Identifies new claim types and potential recoveries (e.g., readmissions, HACs).
• Suggests process improvements and efficiency recommendations.

Skills

ICD-10 coding

Claims auditing

Quality assurance

Recovery auditing

Education

AA/AS

RHIA

RHIT

CCS

CIC

Job description

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient records and generate high-quality recoverable claims across all lines of business. The role emphasizes ICD-10 coding accuracy and DRG assignments based on medical records and physician statements from acute care hospitals.

Candidates should have 5+ years in claims auditing or related fields and relevant certifications such as RHIA/RHIT/CCS/CIC.