Diagnosis Related Group Clinical Validation Auditor
4 months ago
Job Description
:Diagnosis Related Group Clinical Validation Auditor
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Diagnosis Related Group Clinical Validation Auditor 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 a HS diploma or equivalent and 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. Requires current, active, unrestricted Registered Nurse license in applicable state(s).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 billing guidelines, payer reimbursement policies, and coding terminology preferred.For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $83,440 to $150,192
Locations: California; Colorado; District of Columbia (Washington, DC), Nevada; New York; Washington State
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Job Level:
Non-Management ExemptWorkshift:
Job Family:
MED > Licensed NursePlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
-
Clinical Auditor Nurse Specialist
1 week ago
Richmond Heights, Virginia, United States UHS Full timeAbout the RoleWe are seeking a highly skilled and experienced DRG Nurse Auditor to join our team at Universal Health Services (UHS). As a key member of our revenue cycle department, you will play a crucial role in analyzing clinical claim denials, drafting detailed appeal letters, evaluating clinical level of care, and reviewing denial...
-
Auditor - External Financial Services
6 hours ago
Cahaba Heights, Alabama, United States Haynes Downard Full timeHaynes Downard, a leading CPA firm located in Cahaba Heights, is seeking a highly skilled Auditor to join our team. As an external financial services expert, you will play a key role in delivering high-quality audit services to our clients.Your responsibilities will include planning and executing audit assignments, preparing financial statements, and...
-
Senior Internal Auditor
2 months ago
Broadview Heights, United States LHH Recruitment Solutions Full timeJob DescriptionJob DescriptionLHH Recruitment Solutions is seeking a Senior Internal Auditor to join a dynamic and forward-thinking corporate organization committed to excellence and innovation. We are seeking a highly skilled and motivated Senior Internal Auditor to join our client’s team. This role offers an exciting opportunity to contribute to our...
-
Premium Auditor
6 months ago
Maryland Heights, United States Travelers Full timeWho Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine...
-
Jackson Heights, New York, United States USA Clinics Group Full timeAbout This RoleWe are seeking a skilled Ultrasound Sonographer to join our team at USA Clinics Group. In this role, you will perform vascular ultrasound examinations and create Venous Flow Maps for patients. Your responsibilities will include assisting physicians in explaining treatment plans, setting up exam rooms, and maintaining...
-
Auditor - Financial Services Expert
4 days ago
Cahaba Heights, Alabama, United States Haynes Downard Full timeJob OverviewWe are seeking an experienced auditor to join our team at Haynes Downard, a leading CPA firm in Cahaba Heights. The ideal candidate will have a strong accounting background and the ability to ensure client engagements are completed on time and in accordance with professional standards.This position is suited for individuals with a minimum of 3...
-
Highgate Hotel Night Auditor
3 weeks ago
Richmond Heights, Virginia, United States Residence Inn Richmond Full timeResidence Inn Richmond Job OpportunityWe are seeking a highly skilled Night Auditor to join our team at Residence Inn Richmond.About the RoleThe successful candidate will be responsible for reconciling all hotel cashier transactions, reviewing and compiling management reports, ensuring accuracy of guest billings and city ledger transactions, and performing...
-
Night Auditor Professional
2 weeks ago
Richmond Heights, Virginia, United States Charter Senior Living Full timeCompany Overview: Shamin Hotels is an award-winning hospitality organization with over 9,000 rooms in 76 properties. It is recognized as the largest hotel owner and operator throughout Virginia, as well as one of the top ten hotel owners in the country.">">Salary and Benefits: The estimated annual salary for this position is around $40,000 to $60,000,...
-
Senior IT Auditor
3 weeks ago
Fairview Heights, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for executing risk-based IT internal audits, assessing technology controls, and ensuring compliance with regulatory requirements like Sarbanes-Oxley. This role involves drafting audit reports, presenting findings...
-
Senior IT Auditor
3 weeks ago
Fairview Heights, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for executing risk-based IT internal audits, assessing technology controls, and ensuring compliance with regulatory requirements like Sarbanes-Oxley. This role involves drafting audit reports, presenting findings to...
-
Leading Surgeon for a Thriving Medical Group
4 weeks ago
Mendota, Illinois, United States OSF HR Team Full timeGeneral Surgeon PositionWe are seeking a highly skilled General Surgeon to join our medical team in Mendota and Peru, IL.About the RoleThis is a full-time position with a flexible clinic schedule between two hospitals approximately 30 miles apart.Fellowship-trained physicians are welcome to apply.A strong referral base from OSF Medical Group and Primary Care...
-
Clinical Dietitian
2 months ago
Shaker Heights, United States Wingspan Care Group Full timeWingspan Care Group is a nonprofit administrative and management organization that provides a united, community-based network of services so member agencies can focus on mission-related goals. Our innovative model is designed to promote sustainability and advancement among its partner agencies by streamlining operations and eliminating redundancies –...
-
Clinical Case Manager
2 days ago
Cottonwood Heights, Utah, United States LHC Group Full timeLHC Group seeks an experienced Clinical Case Manager to join their team in providing compassionate and personalized hospice care services in Cottonwood, Arizona. As a key member of the hospice care team, you will work closely with patients and their families to develop and implement individualized care plans.Required Qualifications:Certified RN licensure in...
-
Validation Engineer
2 months ago
Sterling Heights, United States DCS Corp Full timeJob DescriptionJob DescriptionMilitary Ground Vehicle Validation Engineer:This position is in support of DCS’s Ground Vehicle System Center (GVSC) Customers servicing as a Validation Engineer with the responsibility of providing technical support to their CAD Validation Team. In support of the CAD Validation Team, the primary function is to review...
-
Senior IT Auditor
2 weeks ago
Fairview Heights, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for conducting risk-based IT internal audits and supporting Sarbanes-Oxley compliance initiatives. This role involves assessing technology controls, documenting processes, and communicating findings to management...
-
Senior IT Auditor
4 weeks ago
Fairview Heights, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for executing risk-based IT internal audits and supporting Sarbanes-Oxley IT testing. The role involves assessing technology control environments, documenting risks, and presenting findings to management. Ideal...
-
Senior IT Auditor
4 weeks ago
Maryland Heights, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for conducting risk-based IT internal audits and ensuring compliance with Sarbanes-Oxley and regulatory requirements. This role involves developing audit plans, assessing technology control environments,...
-
Senior IT Auditor
3 weeks ago
Fairview Heights, IL, United States Enterprise Bank and Trust Full timeSenior IT Auditor (Hybrid Eligible: MO) at Enterprise Bank and Trust summary: The Senior IT Auditor at Enterprise Bank & Trust is responsible for executing risk-based IT internal audits, assessing technology controls, and ensuring compliance with regulatory requirements like Sarbanes-Oxley. This role involves drafting audit reports, presenting findings to...
-
Traveling Physical Therapist
2 days ago
Richmond Heights, Ohio, United States CoreMedical Group Full timeJob Title: Traveling Physical TherapistWe are seeking a skilled and experienced Physical Therapist to join our team as a travel professional. The successful candidate will have the opportunity to work with a reputable healthcare organization, CoreMedical Group, and contribute to the delivery of high-quality patient care.About CoreMedical GroupCoreMedical...
-
Speech Language Pathologist in Mendota Heights, MN
4 months ago
Mendota Heights, United States Soliant Full timeMinimum 1+ years speech therapy experience required.Job Title: School-Based Speech-Language Pathologist (SLP) - Welcoming CFY Candidates Location:Mendota Heights, MN Employment Type: W2 Contract Job Description: We are seeking a dedicated Speech-Language Pathologist (SLP) to join our school-based team. This opportunity is open to both experienced SLPs and...
