Senior DRG Clinical Validation Auditor (Remote)

Elevance Health, Inc.; Tampa (FL); Ibrido; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Elevance Health, Inc. is seeking a Diagnosis Related Group Clinical Validation Auditor to audit inpatient records and ensure clinical documentation supports DRGs billed. The role emphasizes ICD-10 coding, clinical guidelines, and objective audit conclusions.

Requires an RN license and extensive claims auditing experience. The company supports a hybrid, primarily remote work model with in-person training sessions as needed.

Competenze

• Requires AS/AA degree and 8 years of claims auditing experience.
• Requires 5+ years with ICD-9/10CM, MS-DRG, AP-DRG or equivalent.
• Current, active, valid RN license in applicable state(s).

Mansioni

• Audits inpatient medical records to verify documented conditions and DRGs billed.
• Applies ICD-10 coding principles and clinical guidelines to audit conclusions.
• Generates audit determinations and writes detailed findings letters.
• Maintains accuracy and quality standards per audit management.
• Identifies coding/documentation errors and suggests improvements.

Conoscenze

ICD-10 coding

Claims auditing

Clinical guidelines

Audit tools

Formazione

AS/AA degree

RN license

Strumenti

DRG coding systems

Audit workflow systems

Descrizione del lavoro

Elevance Health, Inc. is seeking a Diagnosis Related Group Clinical Validation Auditor to audit inpatient records and ensure clinical documentation supports DRGs billed. The role emphasizes ICD-10 coding, clinical guidelines, and objective audit conclusions.

Requires an RN license and extensive claims auditing experience. The company supports a hybrid, primarily remote work model with in-person training sessions as needed.