Elevance Health
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and
Elevance Health, Los Angeles, California, United States, 90079
Diagnosis Related Group Clinical Validation Auditor‑RN (CDI, MS‑DRG, AP‑DRG and APR‑DRG)
Join to apply for the
Diagnosis Related Group Clinical Validation Auditor‑RN (CDI, MS‑DRG, AP‑DRG and APR‑DRG)
role at
Elevance Health .
Base pay range $81,852 – $155,088 per year.
Job type Remote (virtual) full‑time with optional in‑person training sessions. Candidates must reside within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law.
Responsibilities
Analyze and audit inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed.
Utilize advanced ICD‑10 coding expertise, mastery of clinical guidelines and industry knowledge to substantiate audit conclusions.
Employ audit tools and workflow systems to generate audit determinations and formulate detailed audit findings letters.
Maintain accuracy and quality standards as established by audit management.
Identify potential documentation and coding errors by recognizing aberrant patterns such as inappropriate billing for readmissions, admission status and hospital‑acquired conditions.
Suggest and develop high‑quality, high‑value process improvements and efficiency recommendations.
Minimum Requirements
Current, active, unrestricted Registered Nurse license in applicable state(s).
Minimum 10 years experience in claims auditing, quality assurance, or clinical documentation improvement, with at least 5 years working with ICD‑9/10CM, MS‑DRG, AP‑DRG and APR‑DRG; or an equivalent combination of education and experience.
Preferred Skills, Capabilities and Experience
Certifications such as RHIT, RHIA, CCDS, CDIP, CPC, CCS or CIC.
Experience with third‑party DRG coding and/or clinical validation audits or hospital clinical documentation improvement.
Broad knowledge of clinical documentation improvement guidelines, medical claims billing, provider billing, payer reimbursement policies and coding terminology.
Locations California; Colorado; District of Columbia (Washington, DC); Illinois; New Jersey; Maryland; Minnesota; Nevada; New York; Washington State.
Benefits Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility). The salary offered is based on legitimate, non‑discriminatory factors set by the company and may vary based on geographic location, experience and education.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable law. Applicants requiring accommodation can contact elevancehealthjobssupport@elevancehealth.com.
#J-18808-Ljbffr
Diagnosis Related Group Clinical Validation Auditor‑RN (CDI, MS‑DRG, AP‑DRG and APR‑DRG)
role at
Elevance Health .
Base pay range $81,852 – $155,088 per year.
Job type Remote (virtual) full‑time with optional in‑person training sessions. Candidates must reside within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law.
Responsibilities
Analyze and audit inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed.
Utilize advanced ICD‑10 coding expertise, mastery of clinical guidelines and industry knowledge to substantiate audit conclusions.
Employ audit tools and workflow systems to generate audit determinations and formulate detailed audit findings letters.
Maintain accuracy and quality standards as established by audit management.
Identify potential documentation and coding errors by recognizing aberrant patterns such as inappropriate billing for readmissions, admission status and hospital‑acquired conditions.
Suggest and develop high‑quality, high‑value process improvements and efficiency recommendations.
Minimum Requirements
Current, active, unrestricted Registered Nurse license in applicable state(s).
Minimum 10 years experience in claims auditing, quality assurance, or clinical documentation improvement, with at least 5 years working with ICD‑9/10CM, MS‑DRG, AP‑DRG and APR‑DRG; or an equivalent combination of education and experience.
Preferred Skills, Capabilities and Experience
Certifications such as RHIT, RHIA, CCDS, CDIP, CPC, CCS or CIC.
Experience with third‑party DRG coding and/or clinical validation audits or hospital clinical documentation improvement.
Broad knowledge of clinical documentation improvement guidelines, medical claims billing, provider billing, payer reimbursement policies and coding terminology.
Locations California; Colorado; District of Columbia (Washington, DC); Illinois; New Jersey; Maryland; Minnesota; Nevada; New York; Washington State.
Benefits Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility). The salary offered is based on legitimate, non‑discriminatory factors set by the company and may vary based on geographic location, experience and education.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable law. Applicants requiring accommodation can contact elevancehealthjobssupport@elevancehealth.com.
#J-18808-Ljbffr