Auditor Clinical Validation DRG

Why consider this job opportunity

• Salary up to $45.67 per hour (approximately $95,000 annually)
• Eligible for discretionary bonus consideration
• Comprehensive benefits package, including medical, dental, vision, disability, and life insurance
• Paid family leave and 9 paid holidays per year
• Generous Paid Time Off (PTO) ranging from 17 to 27 days per year, depending on tenure
• Flexible remote work opportunity

• Analyze and audit claims using medical chart coding principles and clinical guidelines
• Utilize proprietary auditing systems to make determinations and generate audit letters
• Maintain production and accuracy goals set by the audit operations management team
• Identify potential claims for additional recoveries and suggest process improvements
• Complete special projects and other duties as assigned

• Associate or bachelor’s degree in nursing with an active/unrestricted license, or in Health Information Management (RHIA or RHIT), or a high school diploma/GED with 5+ years of relevant experience
• Coding/CDI certification (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) required and must be maintained
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
• Expert knowledge of coding guidelines and compliance regulations
• Proficiency in Microsoft Word, Access, Excel, TEAMS, and excellent communication skills

• Experience in claims auditing, quality assurance, or recovery auditing in a DRG/Clinical Validation Audit setting or hospital environment

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