State Licensed Clinical Validation Auditor

Job Summary

Working remotely, the full-time State Licensed Clinical Validation 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 in clear language to explain the rationale behind the review

Required qualifications

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