Clinical Validation Auditor – Auditor III

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

📋 Description

• Conduct reviews of inpatient medical records to ensure DRG codes are substantiated by corresponding documentation.

• Utilize clinical and coding expertise to detect inaccuracies and possible overpayments.

• Present findings in a clear, professional manner, detailing the rationale behind the review.

• Employ industry tools like 3M or Webstrat to aid in decision-making during reviews.

• Operate independently while achieving productivity and quality objectives.

• Keep up to date with clinical guidelines, DRG regulations, and trends within the industry.

⛳️ Requirements

• Active Registered Nurse (RN) license.

• A minimum of 5 years of experience in acute care (preferably within a hospital environment).

• Previous involvement in DRG audits or coding validation is highly advantageous.

• Relevant certifications such as CCS, RHIA, or RHIT are beneficial.

• Familiarity with readmission reviews (PPR) is a plus.

• Capability to articulate clinical decisions with clarity and professionalism.

• Strong time management skills and the ability to maintain focus while working remotely.

• Proficient in using Excel, Word, and OneNote.

• Ability to collaborate effectively as part of a supportive, high-performing team.

• A brief coding/auditing assessment may be included during the interview process.

🏝️ Benefits

• Fully remote work opportunity.

• Up to 10% annual travel for team meetings and limited client onsite interactions.

• A supportive and high-performing team culture.

• Chance to advance in the rapidly changing field of healthcare analytics.

• Training on 3M or Webstrat provided if necessary.