Clinical Validation Auditor

Job Summary

A company is looking for an Auditor Clinical Validation DRG.

Key Responsibilities

• Analyze and audit inpatient claims, integrating medical chart coding principles and clinical guidelines
• Utilize proprietary auditing systems to make audit determinations and generate audit letters
• Meet or exceed productivity and accuracy standards set by audit operations management

Required Qualifications

• Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT), or equivalent experience in claims auditing
• Active coding/CDI certification (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS)
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
• Expert knowledge of coding guidelines and regulatory compliance
• Proficiency in Word, Access, Excel, TEAMS, and other applications