Remote Inpatient DRG Validator – Acute Care

Elevance Health; Wisconsin; Hybrid; USD 95,000 - 150,000; Full time

Benefits offered by this job

Health benefits

Job summary

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high-quality recoverable claims. You will review DRG assignments, ensure coding accuracy, and perform clinical validation across multiple lines of business.

The role emphasizes ICD-10 coding expertise and auditing with opportunities to improve concepts and efficiency in a hybrid work model; 1st shift, with in-person trainings as needed.

Qualifications

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

Responsibilities

• Analyzes and audits claims by integrating clinical principles and guidelines.
• Draws on ICD-10 coding expertise to substantiate audit conclusions.
• Utilizes audit tools and workflows to generate audit determinations and letters.
• Maintains quality standards for auditing concepts and documentation purposes.
• Identifies new claim types for additional recoveries, including readmissions and HACs.
• Suggests improvements to concepts and processes to increase efficiency.

Skills

Claims auditing

Quality assurance

ICD-10 coding

DRG coding knowledge

Education

AA/AS or equivalent

Bachelor's degree preferred

Job description

Elevance Health seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high-quality recoverable claims. You will review DRG assignments, ensure coding accuracy, and perform clinical validation across multiple lines of business.

The role emphasizes ICD-10 coding expertise and auditing with opportunities to improve concepts and efficiency in a hybrid work model; 1st shift, with in-person trainings as needed.