Senior DRG Clinical Validation Auditor - RN (CDI/MS-DRG)

Elevance Health; United States; Hybrid; USD 87,000 - 156,000; Full time

Job summary

Elevance Health is seeking a DRG Clinical Validation Auditor - RN to audit inpatient medical records and ensure documentation supports DRG billing. The role emphasizes ICD-10 coding accuracy, clinical guidelines, and detailed audit findings.

The position supports a hybrid/virtual work model with in-person onboarding and training sessions, and places you within a broader team focused on DRG validation across multiple states in the U.S.

Qualifications

• Requires current, active, unrestricted RN license in applicable state(s).
• Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or equivalent background.
• Preferred certifications: RHIT, RHIA, CCDS, CDIP, CPC or CCS/CIC.
• Experience with third party DRG coding and/or hospital clinical documentation improvement is preferred.

Responsibilities

• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilizes audit tools and workflow systems to generate audit determinations and detailed audit findings letters.
• Maintains accuracy and quality standards as established by audit management.
• Identifies potential documentation and coding errors by recognizing aberrant patterns in coding and documentation.

Skills

DRG auditing

RN license

ICD-10 coding

CDI/DRG knowledge

Auditing tools

Job description

Elevance Health is seeking a DRG Clinical Validation Auditor - RN to audit inpatient medical records and ensure documentation supports DRG billing. The role emphasizes ICD-10 coding accuracy, clinical guidelines, and detailed audit findings.

The position supports a hybrid/virtual work model with in-person onboarding and training sessions, and places you within a broader team focused on DRG validation across multiple states in the U.S.