DRG Clinical Validation Auditor - Manila
Carelon Global Solutions PhilippinesTaguig, Philippines
Posted December 5, 2025
Full Time
About the Company
Carelon Global Solutions makes healthcare operations more practical, effective, and efficient. Our global team of more than 25K innovators drives growth, delivers exceptional support, and develops digital tools specifically for health plans, providers, and systems. Each day, our partners and experts from across the globe implement new ways to save time and money — so doctors can focus on care. Formerly known as Legato Health Technologies, Carelon Global Solutions is part of the Carelon family of brands and is a fully owned subsidiary of Elevance Health. Headquartered in the United States, Carelon Global Solutions has talented teams in India, Ireland, the Philippines, and Puerto Rico. Want to be part of something meaningful? Join our growing team. We believe that when bold talent meets limitless thinking, the possibilities are endless. As part of our Philippines team, you’ll work alongside some of the best minds in the business to solve healthcare’s most complex challenges. You’ll be part of an exciting, fast-paced, and supportive company culture, where all associates receive: • Competitive pay. • Generous benefits. • Training, mentorship, and growth. • Hybrid workplace flexibility. • The opportunity to help others and make a difference. Follow our Carelon Global Solutions Philippines LinkedIn page for the latest job postings and timely company news.
Job Description
Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed.
Requirements
- Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
- 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.
- Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.