RN DRG Clinical Validation Auditor | CDI & DRG Expert

Elevance Health; Durham (NC); 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 ensure DRG accuracy. The role emphasizes ICD-10 coding proficiency, guideline adherence, and detailed audit reporting in a mostly virtual/hybrid setup.

Requires 10+ years in auditing or CDI, with 5+ years in ICD-9/10CM and DRG systems. Hybrid work model with in-person training and potential office commuting distances.

Qualifications

• Active, unrestricted RN license in applicable state(s).
• Minimum 10 years of claims auditing/QA/clinical documentation improvement experience; at least 5 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Analyzes and audits claims by applying medical chart coding principles and clinical guidelines.
• Uses ICD-10 expertise to substantiate audit conclusions.
• Generates audit findings letters and supports audit management standards.
• Maintains accuracy and quality per audit processes.
• Identifies coding/documentation errors such as readmissions, admission status, HACs.
• Suggests process improvements and efficiency recommendations.

Skills

ICD-10 coding

Medical chart auditing

Clinical documentation improvement

Attention to detail

Education

Registered Nurse license

Tools

Audit tools

Audit workflow systems

Job description

Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor - RN to audit inpatient records and ensure DRG accuracy. The role emphasizes ICD-10 coding proficiency, guideline adherence, and detailed audit reporting in a mostly virtual/hybrid setup.

Requires 10+ years in auditing or CDI, with 5+ years in ICD-9/10CM and DRG systems. Hybrid work model with in-person training and potential office commuting distances.