Remote RN – DRG Clinical Validation Auditor

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

Job summary

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor - RN to audit inpatient records and ensure DRG accuracy. This is a virtual, full-time role with required in-person training sessions and occasional office-based alternate locations within commuting distance.

You will apply ICD-10 coding knowledge, clinical guidelines, and auditing tools to produce detailed findings, identify documentation gaps, and support process improvements.

Qualifications

• Requires current, active, unrestricted Registered Nurse license.
• Minimum 10 years in claims auditing or quality assurance.
• Minimum 5 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• RHIT/RHIA/CDDS/CDIP/CPC/CCS or CIC certifications preferred.
• Experience with third party DRG Coding or Clinical Validation Audits preferred.
• Knowledge of clinical documentation improvement guidelines and payer policies.

Responsibilities

• Analyze and audit claims by integrating clinical guidelines and coding principles.
• Utilize ICD-10 coding expertise to support audit conclusions.
• Use audit tools and workflow systems to generate audit determinations.
• Maintain accuracy and quality standards as set by audit management.
• Identify documentation and coding errors, including readmissions and HACs.
• Suggest process improvements to increase efficiency and quality.

Skills

ICD-10 coding

Auditing

Clinical guidelines

Documentation improvement

Education

RHIT

RHIA

CCDS

CDIP

CPC

CCS or CIC

Tools

MS-DRG/AP-DRG/APR-DRG

Job description

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor - RN to audit inpatient records and ensure DRG accuracy. This is a virtual, full-time role with required in-person training sessions and occasional office-based alternate locations within commuting distance.

You will apply ICD-10 coding knowledge, clinical guidelines, and auditing tools to produce detailed findings, identify documentation gaps, and support process improvements.