Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

Elevance Health

Clinical Validation Auditor-RN auditing inpatient medical records for healthcare organization. Analyzing claims, integrating medical chart coding principles, and ensuring documentation supports billing.

Posted 5/31/2026full-timeDenver • California, Colorado, Maryland • 🇺🇸 United StatesSeniorLead💰 $86,560 - $155,808 per yearWebsite

About the role

Key responsibilities & impact

Auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed
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 by recognizing aberrant coding and documentation patterns
Suggesting and developing high quality, high value, concept and or process improvement and efficiency recommendations

Requirements

What you’ll need

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
Preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC), Inpatient Coding Credential (CCS or CIC)

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Paid holidays
Paid Time Off
Medical, dental, vision benefits
Short and long term disability benefits
Life insurance
Wellness programs
Financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims auditingclinical documentation improvementICD-9/10CMMS-DRGAP-DRGAPR-DRGauditing workflow systemsmedical chart coding principlesaudit toolsquality assurance

Soft Skills

attention to detailanalytical skillscommunication skillsproblem-solvingprocess improvementorganizational skillsobjectivityrecommendation developmentquality standards maintenanceerror identification

Certifications

Registered NurseRegistered Health Information Technician (RHIT)Registered Health Information Administrator (RHIA)Certified Clinical Documentation Specialist (CCDS)Certified Documentation Improvement Practitioner (CDIP)Certified Professional Coder (CPC)Inpatient Coding Credential (CCS)Inpatient Coding Credential (CIC)