Remote Inpatient DRG Validator & Medical Records Auditor

Elevance Health, Inc.; Indianapolis (IN); Remote; USD 95,000 - 150,000; Full time

Job summary

Elevance Health is seeking an Inpatient DRG Validator to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role emphasizes clinical reviews of coding accuracy and DRG assignments from acute care hospitals, with virtual work and occasional in-person training.

You will apply ICD-10 coding expertise, reference guidelines, and audit tools to produce findings letters, identify new claim types, and propose process improvements.

Qualifications

• Requires AA/AS or 5+ years in claims auditing, QA, or recovery auditing.
• Certifications: RHIA, RHIT, CCS, or CIC.
• 5+ years' experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

Responsibilities

• Audits inpatient medical records and generates high-quality recoverable claims.
• Reviews DRG coding via physician’s statements from acute care hospitals.
• Audits claims using ICD-10 coding principles and clinical guidelines.
• Identifies new claim types for potential recoveries and improvements.
• Suggests process improvements to enhance efficiency and accuracy.

Skills

ICD-10 coding

Claims auditing

Medical record review

Education

AA/AS or 5+ years experience in claims auditing

Bachelor's degree preferred

RHIA/RHIT/CCS/CIC certifications

Job description

Elevance Health is seeking an Inpatient DRG Validator to audit inpatient medical records and generate high-quality recoverable claims across lines of business. The role emphasizes clinical reviews of coding accuracy and DRG assignments from acute care hospitals, with virtual work and occasional in-person training.

You will apply ICD-10 coding expertise, reference guidelines, and audit tools to produce findings letters, identify new claim types, and propose process improvements.