Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Costa Mesa • California, Colorado, Illinois, Maryland, Minnesota, Nevada, New Jersey, New York, Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $81,852 - $155,088 per year
Job Level
SeniorLead
About the role
- auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed
- specializing in review of Diagnosis Related Group (DRG) paid claims
- analyzing and auditing claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities
- utilizing audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters
- maintaining accuracy and quality standards as established by audit management
- identifying potential documentation and coding errors
- suggesting and developing high quality, high value, improvement recommendations
Requirements
- current, active, unrestricted Registered Nurse license in applicable state(s)
- minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement
- minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG
- certifications preferred: RHIT, RHIA, CCDS, CDIP, CPC, CCS, CIC
- experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred
- broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- health insurance
- paid holidays
- paid time off
- short and long term disability benefits
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims auditingclinical documentation improvementICD-9ICD-10CMMS-DRGAP-DRGAPR-DRGmedical chart codingaudit toolsquality assurance
Soft skills
attention to detailanalytical skillscommunicationproblem-solvingorganizational skills
Certifications
Registered NurseRHITRHIACCDSCDIPCPCCCSCIC