Remote RN: DRG Clinical Validation Auditor

The Elevance Health Companies, Inc.; Indianapolis (IN); Remote; USD 87,000 - 156,000; Full time

Benefits offered by this job

comprehensive benefits package

incentive and recognition programs

equity stock purchase

401k contribution

Job summary

Elevance Health is seeking a DRG Clinical Validation Auditor - RN to audit inpatient medical records for proper DRG coding and documentation. This remote full-time role allows virtual work with occasional in-person training sessions and may consider alternate locations within commuting distance from a supporting office.

Salary ranges from $86,560 to $155,808 based on location and experience. The role requires strong ICD-10 coding proficiency, extensive claims auditing experience, and a deep

Qualifications

• Requires current, active, unrestricted Registered Nurse license in applicable state(s).
• Minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement.
• Minimum of 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or equivalent education/experience.

Responsibilities

• Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Draw on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilize audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
• Maintain accuracy and quality standards as established by audit management.
• Identify potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and HACs.
• Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.

Skills

ICD-10 coding

Clinical guidelines

Medical auditing

ICD-9/10CM exposure

Education

RN license

Job description

Elevance Health is seeking a DRG Clinical Validation Auditor - RN to audit inpatient medical records for proper DRG coding and documentation. This remote full-time role allows virtual work with occasional in-person training sessions and may consider alternate locations within commuting distance from a supporting office.

Salary ranges from $86,560 to $155,808 based on location and experience. The role requires strong ICD-10 coding proficiency, extensive claims auditing experience, and a deep