New York Licensed Clinical Auditor

Job Summary

Seeking a full-time Clinical DRG Auditor, the position focuses on performing inpatient Diagnosis-Related Group (DRG) validation audits and detailed clinical reviews of medical records and claims in a remote work environment.

Key responsibilities

• Conduct comprehensive clinical DRG audits, validating diagnoses, procedures, and discharge statuses according to CMS guidelines
• Produce clear audit findings with documented clinical rationale and support quality assurance processes
• Collaborate with cross-functional teams to enhance audit logic and inform AI-driven review models

Required qualifications

• Active Registered Nurse (RN) license
• 3+ years of experience in clinical DRG validation, inpatient clinical review, or similar payment integrity work
• Strong ability to interpret inpatient medical records and assess clinical validity of diagnoses and procedures
• Experience applying clinical judgment in a reimbursement or audit context