DRG Validation Auditor - Evening/Night Shift

Cotiviti; Oregon; Presencial; USD 52 000 - 74 000; Tempo integral

Resumo da oferta

Cotiviti is seeking a DRG Validation Auditor focused on Cross Claim Clinical Reviews (CCCR). The role conducts DRG validation for prepay and retrospective audits without a medical record, emphasizing clinical validation and coding accuracy.

The position is full-time with an off-hour shift from 3 PM-11 PM or 11 PM-7 AM ET, including weekends and holidays. A strong inpatient HIM coding background is required.

Qualificações

• Associate or bachelor’s degree in nursing (active/unrestricted license).
• Associate or bachelor’s degree Health Information Management (RHIA or RHIT).
• High school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing—ideally in a DRG/Clinical Validation Audit setting or a hospital environment.

Responsabilidades

• Analyze and audit inpatient claims and document results.
• Use Cotiviti auditing systems to determine audit letters.
• Maintain productivity and quality standards.
• Identify new claim types and potential recoveries.
• Suggest process improvements and tools.
• Complete tasks per annual Performance Plan.

Conhecimentos

ICD-10 coding

DRG concepts

Communication skills

Quality assurance

Formação académica

Nursing degree (RN)

RHIA or RHIT

High school diploma + 5+ years claims auditing

Ferramentas

Word

Access

Excel

Teams

Descrição da oferta de emprego

Cotiviti is seeking a DRG Validation Auditor focused on Cross Claim Clinical Reviews (CCCR). The role conducts DRG validation for prepay and retrospective audits without a medical record, emphasizing clinical validation and coding accuracy.

The position is full-time with an off-hour shift from 3 PM-11 PM or 11 PM-7 AM ET, including weekends and holidays. A strong inpatient HIM coding background is required.