Clinical Validation Auditor

Job Summary

Focused on Coding and Clinical Chart Validation for inpatient audits, the full-time Clinical Validation Auditor will analyze claims, utilize proprietary audit tools, and maintain productivity and accuracy standards in a remote work environment.

Key responsibilities

• Analyzes and audits inpatient claims, applying advanced ICD-10 coding expertise and clinical guidelines
• Utilizes proprietary auditing systems to make determinations and generate audit letters effectively
• Meets or exceeds productivity and accuracy standards set by the audit operations management team

Required qualifications

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