Senior DRG Clinical Validation Auditor (Remote)

Elevance Health; Indianapolis (IN); On-site; USD 87,000 - 130,000; 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 Patient Safety DRG Clinical Validation Auditor to audit inpatient medical records and ensure documentation supports DRGs billed and reimbursed. The role requires extensive ICD-10 coding expertise and experience in DRG-related auditing.

The candidate will analyze claims, generate detailed audit findings, and suggest process improvements. A current RN license is required, with a minimum of 10 years in audits or clinical documentation improvement.

Qualifications

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in audit activities.
• Draws on ICD-10 coding expertise and clinical guidelines to substantiate conclusions.
• Maintains accuracy and quality standards in audit management.

Responsibilities

• Audits inpatient medical records to ensure clinical documentation supports DRGs billed.
• Uses audit tools and workflow systems to generate audit determinations and findings letters.
• Identifies documentation and coding errors and aberrant patterns in claims.

Skills

ICD-10 coding

Auditing

Medical claims auditing

Education

Registered Nurse (RN) license

Job description

Elevance Health is seeking a Patient Safety DRG Clinical Validation Auditor to audit inpatient medical records and ensure documentation supports DRGs billed and reimbursed. The role requires extensive ICD-10 coding expertise and experience in DRG-related auditing.

The candidate will analyze claims, generate detailed audit findings, and suggest process improvements. A current RN license is required, with a minimum of 10 years in audits or clinical documentation improvement.