Remote RN: DRG Clinical Validation Auditor (CDI & DRG)

Elevance Health; Las Vegas (NV); Hybrid; USD 87,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor – RN to audit inpatient records and ensure documentation supports DRGs billed. This role requires an active RN license and 10+ years in claims auditing with 5+ years in ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

This virtual/hybrid position offers flexibility with in-person training and occasional office visits within commuting distance of the posting location. Relocation within a reasonable distance may be considered.

Qualifications

• Active RN license in applicable state(s).
• Minimum 10 years in claims auditing, quality assurance, or clinical documentation improvement.
• Minimum 5 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objective auditing practices.
• Uses advanced ICD-10 coding expertise and guidelines to substantiate conclusions.
• Utilizes audit tools and workflow systems to generate audit determinations and detailed findings letters.
• Maintains accuracy and quality standards as established by audit management.
• Identifies documentation and coding irregularities, such as inappropriate readmissions or HACs, to suggest improvements.

Skills

Auditing

Healthcare compliance

ICD-10 coding knowledge

Education

Registered Nurse (RN) license

Tools

ICD-9/10CM

MS-DRG

AP-DRG

APR-DRG

Job description

Elevance Health seeks a Diagnosis Related Group Clinical Validation Auditor – RN to audit inpatient records and ensure documentation supports DRGs billed. This role requires an active RN license and 10+ years in claims auditing with 5+ years in ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

This virtual/hybrid position offers flexibility with in-person training and occasional office visits within commuting distance of the posting location. Relocation within a reasonable distance may be considered.