Texas Licensed Clinical Auditor

Job Summary

To support a growing healthcare team, the full-time Texas Licensed Clinical Auditor will perform DRG validation reviews of medical records, ensuring accurate coding and compliance with clinical documentation standards in a remote setting.

Key responsibilities

• Review medical records to verify coding accuracy and supporting clinical documentation
• Conduct audits to ensure correct reimbursement and identify potential savings
• Assist the Quality Control team with appeals and notify leadership of any concerns

Required qualifications

• Texas LVN or RN license preferred
• Minimum of 2 years of recent DRG Quality Auditing experience in a hospital or health plan
• National Coding Certification through AHIMA or AAPC required
• Extensive hands-on experience with ICD-10 CM/PCS coding
• Strong knowledge of Medicare and CMS guidelines