Clinical Validation Auditor III

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

📋 Description

• Review inpatient medical records to ensure that DRG codes are substantiated by documentation.

• Utilize clinical and coding expertise to pinpoint inaccuracies and potential overpayments.

• Document findings and articulate the rationale behind the reviews clearly.

• Employ industry tools such as 3M or Webstrat to aid in audit decisions.

• Work autonomously while achieving productivity and quality targets.

• Stay updated with clinical guidelines, DRG regulations, and industry developments.

⛳️ Requirements

• Active Registered Nurse (RN) license is required.

• A minimum of 5 years of acute care experience, ideally in a hospital environment.

• Experience in DRG audits or coding validation is advantageous.

• CCS, RHIA, or RHIT certifications are preferred.

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

• Capability to convey clinical decisions clearly and professionally.

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

• Proficiency in using Excel, Word, and OneNote.

• Ability to work independently while meeting productivity and quality standards.

• A brief coding/auditing assessment may be part of the interview process.

🏝️ Benefits

• Fully remote work environment.

• Opportunity for up to 10% annual travel for team meetings and limited client onsite engagements.

• Supportive and high-performing team culture.

• Opportunities for continuous improvement and professional development.

• Training on industry tools such as 3M or Webstrat will be provided if necessary.