Registered Nurse Clinical Auditor

Job Summary

Seeking a detail-oriented Registered Nurse Clinical Auditor, the fully remote Clinical Validation Auditor will review inpatient medical records, validate DRG codes, and identify potential overpayments using clinical judgment and coding knowledge.

Key responsibilities

• Review inpatient medical records to verify accuracy of DRG codes based on documentation
• Apply clinical and coding knowledge to identify inaccuracies and potential overpayments
• Document findings clearly and professionally, explaining the rationale behind reviews

Required qualifications

• Active Registered Nurse (RN) license
• 5+ years of acute care experience, preferably in a hospital setting
• Experience in DRG audits or coding validation is highly preferred
• Certifications such as CCS, RHIA, or RHIT are a plus
• Knowledge of readmission reviews (PPR) is advantageous