Auditor Clinical Validation DRG

Y-Axis; Northern (KY); Hybrid; USD 86,000 - 105,000; Full time

Benefits offered by this job

Competitive hourly compensation

Discretionary performance bonus

Comprehensive benefits

401(k) retirement plan

Paid family leave

Generous PTO

Fully remote work

Impactful healthcare audits

Job summary

Y-Axis is seeking an Auditor Clinical Validation DRG to perform in-depth inpatient claim audits, applying DRG/APR-DRG, ICD-10 coding, and medical necessity guidelines. This fully remote role requires strong clinical judgment, detail-oriented review, and proficiency with Excel and MS Teams to document findings and support payer compliance.

The ideal candidate has 5+ years in healthcare auditing or coding, with CMS guidelines knowledge and the ability to work independently in a remote setting,

Qualifications

• Strong clinical and coding expertise in healthcare auditing and claims validation.
• Experience with DRG/APR-DRG and ICD-9/10 coding.
• Ability to work independently in a remote, compliance-focused setting.

Responsibilities

• Perform detailed inpatient claim audits to validate DRG/APR-DRG assignments and coding compliance.
• Identify recovery opportunities and improve audit tools/workflows.
• Maintain productivity with high accuracy and audit standards.
• Document findings and prepare audit correspondence.

Skills

Clinical Validation

DRG Auditing

ICD-10 Coding

Medical Necessity Review

Claims Validation

Revenue Integrity

Analytical Thinking

Clinical Judgment

Medical Documentation

Compliance Auditing

Microsoft Excel

Education

Associate or bachelor’s degree in Nursing (active, unrestricted license)

Health Information Management (RHIA/RHIT)

Equivalent experience with high school diploma/GED

Tools

Microsoft Excel

Microsoft Teams

Access

Job description

Auditor Clinical Validation DRG at Jobgether

, , United States - Full Time

Immediate

04 Oct, 26

95000.0

06 Jul, 26

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

• Clinical Validation
• DRG Auditing
• ICD-10 Coding
• Medical Necessity Review
• Claims Validation
• Revenue Integrity
• Analytical Thinking
• Clinical Judgment
• Medical Documentation
• Compliance Auditing
• Microsoft Excel
• Microsoft Teams

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Auditor Clinical Validation DRG based in United States.This role plays a critical part in ensuring the accuracy, compliance, and integrity of inpatient medical claims through detailed clinical and coding validation. The specialist will review complex inpatient records, applying advanced DRG, APR-DRG, and ICD-10 coding expertise to assess appropriateness of care, billing accuracy, and medical necessity. Working independently in a remote environment, this professional contributes to identifying recovery opportunities and improving audit processes that directly impact healthcare cost integrity and quality assurance. The position requires strong clinical judgment, analytical precision, and the ability to translate medical documentation into accurate audit outcomes. It is well-suited for experienced healthcare auditors or clinicians with a strong coding background who thrive in detail-oriented, compliance-driven work. This role also offers the opportunity to contribute to process improvements in a fast-paced, data-driven audit environment. Strong communication and consistency in high-quality documentation are essential to success.

Accountabilities

• The Auditor Clinical Validation DRG is responsible for performing detailed inpatient claim audits with a focus on clinical accuracy, coding compliance, and reimbursement integrity.
• Conduct comprehensive inpatient claims audits using clinical records, coding guidelines, and regulatory standards to validate DRG/APR-DRG assignments.
• Apply advanced ICD-10, MS-DRG, APR-DRG, and related coding knowledge to support audit findings and ensure compliance with payer and CMS guidelines.
• Utilize proprietary audit systems and tools to document findings, generate audit determinations, and prepare formal audit correspondence.
• Maintain required productivity levels while ensuring accuracy, quality, and adherence to audit standards.
• Identify claims outside of standard audit scope that may present additional recovery opportunities or risk areas.
• Contribute to continuous improvement efforts by suggesting enhancements to audit tools, methodologies, and workflows.
• Complete assigned responsibilities, special projects, and performance objectives in alignment with organizational expectations.

Requirements

• This role requires strong clinical and coding expertise combined with experience in healthcare auditing, claims validation, or revenue integrity environments.
• Candidates must be highly detail-oriented and comfortable working independently in a structured, compliance-focused setting.
• Associate or bachelor’s degree in Nursing (active, unrestricted license) OR Health Information Management (RHIA/RHIT) OR equivalent experience with high school diploma/GED and 5+ years in auditing or healthcare claims.
• One or more active certifications required: RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS.
• 5–7+ years of experience working with ICD-9/10, MS-DRG, APR-DRG, and inpatient coding and billing systems.
• Strong knowledge of medical necessity criteria, payer reimbursement rules, and regulatory compliance standards (CMS and coding clinic guidance).
• Proficiency with standard office tools such as Word, Excel, Access, and collaboration platforms like Microsoft Teams.
• Strong analytical thinking, attention to detail, and ability to assess complex medical documentation accurately.
• Excellent written and verbal communication skills for audit documentation and findings.
• Ability to work independently in a remote environment with a secure, dedicated workspace and reliable high-speed internet.

Benefits

• Competitive hourly compensation (approximately $45.67/hour, annualized around $95K)
• Eligibility for discretionary performance bonus
• Comprehensive medical, dental, vision, life, and disability insurance coverage
• 401(k) retirement savings plan
• Paid family leave and paid holidays (9 per year)
• Generous PTO allowance (17–27 days depending on tenure and level)
• Fully remote work arrangement with flexible home-office setup requirements
• Opportunity to work on high-impact healthcare audit and compliance initiatives

Responsibilities

Perform detailed inpatient claim audits to validate DRG/APR-DRG assignments and ensure coding compliance. Identify recovery opportunities and contribute to the improvement of audit tools and workflows.