State Licensed Clinical DRG Auditor
Job Summary
Seeking an experienced State Licensed Clinical DRG Auditor, the full-time remote position will perform inpatient Diagnosis-Related Group (DRG) validation audits and detailed clinical reviews of medical records and claims to improve payment accuracy and support audit automation.
Key responsibilities
- Conduct comprehensive clinical DRG audits on inpatient claims, validating diagnoses and procedures according to CMS guidelines
- Produce clear audit findings and document determinations in the audit platform
- Collaborate with cross-functional teams to provide clinical insights that enhance audit logic and processes
Required qualifications
- Active Registered Nurse (RN) license
- 3+ years of experience in clinical DRG validation, inpatient clinical review, or DRG auditing
- Strong ability to interpret inpatient medical records and assess clinical validity
- Experience applying clinical judgment in reimbursement or audit contexts
Complete Job Description
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