Clinical Validation Auditor

Job Summary

Focused on auditing inpatient claims, the full-time Clinical Validation Auditor will utilize coding and clinical expertise to analyze claims, ensure coding accuracy, and document audit results, all while working remotely.

Key responsibilities

• Analyzes and audits claims using advanced ICD-10 coding expertise and clinical guidelines
• Effectively utilizes proprietary auditing systems to make audit determinations and generate reports
• 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 in claims auditing
• Active coding/CDI certification such as 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 compliance regulations
• Proficiency in Word, Access, Excel, and TEAMS