Auditor Clinical Validation DRG

Cotiviti - US; United States; Remote; USD 95,000; Full time

Job summary

A leading company in healthcare auditing is seeking a qualified auditor to join their remote team. Candidates will be responsible for analyzing inpatient claims using advanced coding expertise and must hold relevant certifications and experience. This opportunity offers a competitive salary, comprehensive benefits, and a supportive work environment that prioritizes professional growth.

Benefits

Comprehensive benefits package

Generous Paid Time Off (PTO)

Discretionary bonus consideration

Flexible remote work arrangements

Qualifications

• Coding/CDI certification (RHIA, RHIT, CPC, CCS, CIC, CDIP, 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 payer reimbursement policies.

Responsibilities

• Analyze and audit inpatient claims using advanced ICD-10 coding expertise.
• Utilize proprietary auditing systems to make audit determinations.
• Identify new claim types and suggest process improvements.

Skills

ICD-10 coding expertise

Medical necessity criteria

Communication skills

Education

Associate or bachelor’s degree in nursing

Health Information Management (RHIA or RHIT)

Tools

Word

Access

Excel

TEAMS

Job description

Employer Industry: Healthcare Auditing

Why consider this job opportunity:
- Salary up to $45.67 per hour (approximately $95,000 annualized)
- Eligible for discretionary bonus consideration
- Comprehensive benefits package including medical, dental, vision, and life insurance
- Generous Paid Time Off (PTO) ranging from 17-27 days per year based on tenure
- Opportunity to work remotely with flexible arrangements
- Supportive and collaborative work environment focused on professional growth

What to Expect (Job Responsibilities):
- Analyze and audit inpatient claims using advanced ICD-10 coding expertise and clinical guidelines
- Utilize proprietary auditing systems to make audit determinations and generate audit letters
- Meet or exceed productivity and accuracy standards set by management
- Identify new claim types and suggest process improvements for auditing practices
- Complete special projects and other duties as assigned

What is Required (Qualifications):
- Associate or bachelor’s degree in nursing (active/unrestricted license) or Health Information Management (RHIA or RHIT)
- Coding/CDI certification (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, payer reimbursement policies, and medical necessity criteria
- Proficiency in Word, Access, Excel, TEAMS, and other relevant applications

How to Stand Out (Preferred Qualifications):
- Strong written and verbal communication skills
- Working knowledge of applicable industry-based standards
- Ability to assess the accuracy and thoroughness of assigned work

#HealthcareAuditing #RemoteWork #CareerOpportunity #CompetitivePay #BenefitsPackage

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