Clinical Validation Auditor

Job Summary

A company is looking for a Clinical Validation Auditor III.

Key Responsibilities

• Conduct MS-DRG and/or APR-DRG clinical reviews to verify the accuracy of DRG assignments
• Document audit results clearly using clinical guidelines and coding rules
• Utilize proprietary tools to make audit determinations and comply with clinical guidelines

Required Qualifications

• Registered Nurse with an Associate's or Bachelor's degree
• 5+ years of acute care nursing experience, preferably with clinical or coding validation audit experience
• Experience in DRG retrospective overpayment identification auditing is preferred
• Preference for candidates with CCS, RHIA, or RHIT coding credentials
• Prior readmission (PPR) auditing experience is preferred