Clinical Validation Auditor III

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

📋 Description

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

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

• Clearly and professionally record findings, including the justification for review conclusions.

• Employ industry tools like 3M or Webstrat to aid in audit determinations.

• Operate independently while achieving productivity and quality targets.

• Keep up-to-date with clinical guidelines, DRG regulations, and industry developments.

⛳️ Requirements

• Bachelor’s Degree.

• Registered Nurse (RN) with a valid license.

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

• Experience in DRG audits or coding validation is advantageous.

• Certifications such as CCS, RHIA, or RHIT are preferred.

• Familiarity with readmission reviews (PPR) is beneficial.

• Capability to articulate clinical decisions clearly and professionally.

• Skill in effectively managing time and maintaining focus while working remotely.

• Proficiency in using Excel, Word, and OneNote.

• Ability to collaborate within a supportive, high-performing team.

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

🏝️ Benefits

• Complete remote work / work-from-home flexibility.

• Supportive and collaborative culture.

• Opportunities for growth in healthcare analytics.

• Training on industry tools such as 3M or Webstrat available if required.