Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

Skip to main contentWe care about your privacyBy clicking "Accept All", you agree to the storing of cookies on your device to give you the most optimal experience using our website. We may also use cookies to enhance performance, analyze site usage and to personalize your experience.Read Full Privacy MessageDeclineAccept CookiesCareers at Elevance HealthEnglishSign InDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) page is loadedDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)ApplylocationsOH-MASON, 4361 IRWIN SIMPSON RDGA-ATLANTA, 740 W PEACHTREE ST NWCA-COSTA MESA, 3080 BRISTOL ST, STE 200MD-HANOVER, 7550 TEAGUE RD, STE 500MN-GILBERT, 730 S BROADWAYView All 12 Locationsposted onPosted 5 Days Agotime left to applyEnd Date: July 31, 2026 (9 days left to apply)job requisition idJR194009Anticipated End Date:2026-07-31Position Title:Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)Job Description:Title: Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)Virtual: This role enables associates to work virtually full-time, with the exception of required inperson training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.The Diagnosis Related Group Clinical Validation Auditor-RN is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.How you will make an impact: Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.Maintains accuracy and quality standards as established by audit management.Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.Minimum Requirements:Requires current, active, unrestricted Registered Nurse license in applicable state(s).Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities and Experiences: One or more of the following certifications are 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) or Inpatient Coding Credential such as CCS or 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...