Remote Inpatient DRG Validator - Acute Care Audits

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

Benefits offered by this job

Comprehensive benefits

401(k) plan

Stock purchase plan

Job summary

Elevance Health in the United States seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims across all lines of business. You will evaluate DRG accuracy and coding through clinical reviews and hospital documentation.

The role requires advanced ICD-10/DRG expertise and collaboration with providers to improve accuracy and recoveries. Remote work with occasional in-person training is available, with a competitive salary and

Qualifications

• AA/AS or 5+ years claims auditing experience.
• RHIA/RHIT/CCS/CIC certifications may be required.
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audits inpatient claims using ICD-10 coding principles and clinical guidelines.
• Substantiates conclusions with coding guidelines and industry knowledge.
• Uses audit tools and workflow systems to generate audit findings letters.
• Maintains accuracy and quality standards for valid claim identifications and documentation.
• Identifies new claim types for potential recoveries (readmissions, HACs, etc.).
• Suggests process improvements to increase efficiency and recoveries.

Skills

DRG coding

ICD-10 proficiency

Auditing & QA

Clinical guidelines

Education

AA/AS or 5+ years claims auditing

Bachelor’s degree preferred

Tools

None

Job description

Elevance Health in the United States seeks an Inpatient DRG Validator (Acute Care) to audit inpatient medical records and generate high quality recoverable claims across all lines of business. You will evaluate DRG accuracy and coding through clinical reviews and hospital documentation.

The role requires advanced ICD-10/DRG expertise and collaboration with providers to improve accuracy and recoveries. Remote work with occasional in-person training is available, with a competitive salary and