Clinical Validation Auditor – Auditor III

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine inpatient medical records to ensure the DRG (Diagnosis-Related Group) code aligns with the provided documentation.

• Utilize your clinical and coding expertise to detect discrepancies and uncover potential overpayments.

• Clearly document your observations in professional language that articulates the reasoning behind your assessment.

• Leverage industry tools such as 3M or Webstrat to inform your decisions.

• Function independently while achieving productivity and quality objectives.

• Keep abreast of clinical guidelines, DRG regulations, and industry developments.

⛳️ Requirements

• Active Registered Nurse (RN) license.

• Over 5 years of experience in acute care (hospital environment preferred).

• Experience with DRG audits or coding validation is highly advantageous!

• Additional qualifications such as CCS, RHIA, or RHIT certifications are a bonus.

• Familiarity with readmission reviews (PPR) is also beneficial.

🏝️ Benefits

• Flexible remote work options.

• A supportive workplace culture.

• Opportunities for growth within healthcare analytics.