Clinical Validation Auditor RN

Job Summary

Working remotely, the full-time Clinical Validation Auditor RN will apply expert knowledge of MS-DRG and APR-DRG coding methodologies to audit inpatient claims, validate ICD-10 codes, and identify overpayments while composing rationales to support audit findings.

Key responsibilities:

• Conduct MS-DRG and APR-DRG coding reviews to verify accuracy of DRG assignments and identify overpayments
• Utilize expert knowledge to ensure correct ICD-10 code assignments and compliance with coding guidelines
• Write clear rationales supporting audit findings and manage daily case review assignments with a focus on quality

Required qualifications:

• Associate's degree
• Unrestricted RN (Registered Nurse) license
• CCS/CIC certification or willingness to obtain within 6 months of hire
• 2+ years of MS DRG/APR DRG coding experience in a hospital environment
• 2+ years of ICD-10-CM and ICD-10-PCS coding experience with expert knowledge of coding guidelines