State Licensed Clinical Auditor
Job Summary
Working remotely, the full-time State Licensed Clinical Auditor will review inpatient medical records to validate DRG codes, apply clinical judgment to identify inaccuracies, and document findings to ensure accurate medical claims coding.
Key responsibilities
- Review inpatient medical records to verify the accuracy of DRG codes based on documentation
- Apply clinical and coding knowledge to identify potential overpayments and inaccuracies
- Document findings clearly and professionally, explaining the rationale behind reviews
Required qualifications
- Active Registered Nurse (RN) license
- 5+ years of experience in an acute care setting (hospital preferred)
- Experience in DRG audits or coding validation is a significant plus
- Certifications such as CCS, RHIA, or RHIT are advantageous
- Knowledge of readmission reviews (PPR) is a plus
Complete Job Description
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