Clinical Validation Auditor

Job Summary

A company is looking for an Auditor Clinical Validation DRG.

Key Responsibilities

• Analyze and audit inpatient claims, integrating medical coding principles and clinical guidelines
• Utilize proprietary auditing systems to make determinations and generate audit letters
• Meet productivity and accuracy standards while identifying potential new claim types for recovery

Required Qualifications

• Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT)
• Certification in coding/CDI (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS)
• 5 to 7+ years of experience with ICD-9/10CM and DRG systems
• Expert knowledge of coding guidelines and medical claims billing/payment systems
• Proficiency in Microsoft Office applications