DRG Validation Auditor – Off Hours Work

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

📋 Description

• Reviews and evaluates claims for accuracy and compliance.

• Applies medical chart coding principles, clinical guidelines, and objectivity during medical audit processes.

• Leverages advanced ICD-10 coding knowledge, clinical guidelines, and industry insights to support findings.

• Conducts tasks autonomously.

• Proficiently employs audit tools.

• Operates Cotiviti proprietary auditing systems with a strong level of expertise to make audit decisions and create audit correspondence.

• Achieves or surpasses productivity standards established by the audit operations management team.

• Meets or exceeds accuracy and quality benchmarks.

• Identifies new claim categories.

• Proposes and develops innovative, high-value concepts or process improvement tools.

⛳️ Requirements

• An associate or bachelor’s degree in nursing (with an active/unrestricted license).

• An associate or bachelor’s degree in Health Information Management (RHIA or RHIT).

• A high school diploma or GED combined with at least 5 years of relevant experience in claims auditing, preferably within a DRG / Clinical Validation Audit context or hospital setting.

• Coding/CDI Certification (at least one of the following is required): RHIA or RHIT, CPC, Inpatient Coding Credential – CCS, CIC, CDIP, or CCDS.

• 5 to 7+ years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, along with familiarity with medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, and medical necessity criteria.

• In-depth coding expertise in DRG, APRDRG, ICD-10, CPT, and HCPCS codes.

• Proficient in Word, Access, Excel, TEAMS, and other relevant applications.

• Strong written and verbal communication abilities.

🏝️ Benefits

• Comprehensive medical, dental, vision, disability, and life insurance coverage.

• 401(k) retirement savings plans.

• Paid family leave.

• Nine paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, based on specific levels and length of service with Cotiviti.