Clinical Validation Auditor

Job Summary

A company is looking for an Auditor Clinical Validation DRG.

Key Responsibilities

• Analyzes and audits inpatient claims, integrating medical chart coding principles and clinical guidelines
• Utilizes proprietary auditing systems to make audit determinations and generate audit letters
• Maintains productivity and accuracy standards set by management while identifying new claim types for potential recoveries

Required Qualifications

• Associate or bachelor's degree in nursing or Health Information Management (RHIA or RHIT), or equivalent experience with a high school diploma/GED
• Certification in coding/CDI (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS) required
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG
• Expert knowledge of coding guidelines and compliance regulations
• Proficiency in Microsoft Office applications