Diagnosis Related Group Clinical Validation Auditor

✨ About The Role

- The role involves auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed.
	- Candidates will analyze and audit claims by integrating medical chart coding principles and clinical guidelines.
	- The position requires mastery of advanced ICD-10 coding expertise and industry knowledge.
	- The auditor will utilize audit tools and workflow systems to generate audit determinations and findings.
	- Maintaining accuracy and quality standards as established by audit management is a key responsibility.
                            

⚡ Requirements

- The ideal candidate will have a current, active, unrestricted Registered Nurse license in applicable states.
	- A minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement is required.
	- Candidates should possess at least 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
	- Preferred certifications include Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), or Certified Professional Coder (CPC).
	- Strong analytical skills and attention to detail are essential for identifying documentation and coding errors.
                            

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Diagnosis Related Group Clinical Validation Auditor - rn

Indianapolis, Indiana, United States

$83,440 - 150,192 USD / year

Registered Nurse

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About Elevance Health

Elevance Health is a health insurance provider offering a range of healthcare services and insurance plans.