Clinical Validation Auditor RN

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 accuracy of DRG assignments
• Document audit results using clinical guidelines and coding rules
• Utilize proprietary tools to make audit determinations and manage claims workflow

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 with DRG retrospective overpayment identification auditing preferred
• Prior readmission auditing experience is desirable
• CCS, RHIA, or RHIT coding credentials are preferred