Diagnosis Related Group Clinical Validation Auditor-RN

Elevance Health - Wallingford, CT

Job Title: Diagnosis Related Group Clinical Validation Auditor-RN

Position: Clinical Auditor

Job Type: Full Time

Pay: $81,852 to $155,088

Shift:

Work Type: Virtual

Location

Address:

City: Wallingford

State: CT

ZIP Code:

Job Responsibilities

Audit inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed.
Analyze and audit claims by integrating medical chart coding principles, clinical guidelines, and objectivity.
Utilize advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate audit conclusions.
Use audit tools, auditing workflow systems, and reference info 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 and recognize aberrant coding and documentation patterns.
Suggest and develop high quality, high value, concept and/or process improvement and efficiency recommendations.

Required Skills

Core Skills

ICD-9/10CM proficiency
Claims auditing
Clinical documentation improvement
Medical coding knowledge

Preferred Skills

Registered Health Information Technician (RHIT)
Registered Health Information Administrator (RHIA)
Certified Clinical Documentation Specialist (CCDS)
Certified Documentation Improvement Practitioner (CDIP)
Certified Professional Coder (CPC)
CCS or CIC certification
Experience with third party DRG Coding or Clinical Validation Audits

Requirements

Experience: Minimum of 10 years in claims auditing, quality assurance, or clinical documentation improvement; minimum of 5 years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG

Education:

License & Certification:

Current, active, unrestricted Registered Nurse license

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

Supplemental Pay

Not specified

Special Notes

Company committed to equal pay opportunities regardless of gender, race, or other protected categories.
Actual compensation may vary based on location, experience, education, and market/business considerations.