Patient Safety Clinical Validation Auditor

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Conduct audits of inpatient medical records to verify that clinical documentation aligns with billed conditions and DRGs.

• Examine Diagnosis Related Group (DRG) claims that have been paid.

• Assess and review claims utilizing medical chart coding standards, clinical guidelines, and objective auditing practices.

• Employ advanced ICD-10 coding knowledge and clinical guidelines to validate audit conclusions.

• Utilize audit tools, workflow systems, and reference materials to produce audit determinations.

• Prepare comprehensive audit findings letters.

• Uphold the accuracy and quality standards set by audit management.

• Detect documentation and coding discrepancies, including improper readmissions, inpatient admission statuses, and Hospital-Acquired Conditions.

• Propose and create recommendations for process enhancements, efficiencies, and high-value improvements.

⛳️ Requirements

• A current, active, unrestricted Registered Nurse license in the relevant state(s).

• At least 10 years of experience in claims auditing, quality assurance, or clinical documentation enhancement.

• A minimum of 5 years working with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG.

• An equivalent combination of education and experience may be considered.

• Preferred experience in third-party DRG coding and/or clinical validation audits or in hospital clinical documentation improvement.

• Broad understanding of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing standards, payer reimbursement policies, and coding terminology is preferred.

• Desired certifications include CCDS, CDIP, CPC, CCS, or CIC.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with company match.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Flexibility for virtual work.

• Required in-person training sessions.