Remote RN: DRG Validation Auditor (MS/AP/APR-DRG)

Elevance Health; Denver (CO); Hybrid; 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 verify that documentation supports DRGs billed. The role emphasizes ICD-10 coding, clinical guidelines, and audit-driven findings.

You will leverage advanced coding knowledge, audit tools, and industry guidelines to substantiate conclusions, while ensuring accuracy and compliance. Hybrid/virtual work with in-person trainings offered, nationwide location flexibility.

Qualifications

• ICD-10 coding expertise and clinical guidelines
• Auditing tools and workflow systems knowledge
• Experience in evaluating medical charts for documentation accuracy
• Understanding of payer policies and DRG billing logic
• Strong analytical and communication skills

Responsibilities

• Audits inpatient records to ensure documentation supports DRGs billed
• Uses ICD-10 coding principles and guidelines to substantiate conclusions
• Generates audit determinations and detailed findings letters
• Maintains quality standards per audit management directions
• Identifies documentation and coding errors such as readmissions or HACs
• Suggests process improvements to enhance accuracy and efficiency

Skills

ICD-10 coding

Audit analytics

Medical chart review

Regulatory compliance

Education

Registered Nurse license

Job description

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor-RN to audit inpatient records and verify that documentation supports DRGs billed. The role emphasizes ICD-10 coding, clinical guidelines, and audit-driven findings.

You will leverage advanced coding knowledge, audit tools, and industry guidelines to substantiate conclusions, while ensuring accuracy and compliance. Hybrid/virtual work with in-person trainings offered, nationwide location flexibility.