Inpatient DRG Validation Auditor (Evenings/Nights)

Cotiviti; United States; Remote; USD 52,000 - 74,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k)

Paid family leave

Holidays & PTO

Job summary

Cotiviti seeks a DRG Validation Auditor to perform cross claim clinical reviews and DRG validation for prepay and retrospective audits without medical records. You’ll audit inpatient claims, document results, and ensure coding accuracy and appropriate treatment settings.

The role is full-time with off-hour shifts (3 PM-11 PM or 11 PM-7 AM ET), weekends/holidays, and a base hourly rate of $45.67 with discretionary bonus eligibility.

Qualifications

• Bachelor's degree or nursing degree with active license.
• RHIA, RHIT, CPC or inpatient coding credentials are required and maintained.
• 5+ years of claims auditing, quality assurance or recovery auditing experience.
• Expert knowledge of DRG/ICD-10 coding and CMS guidelines.
• Proficiency in Word, Excel, Access, TEAMS and related tools.
• Strong written and verbal communication skills.

Responsibilities

• Audit inpatient claims focusing on clinical validation and coding accuracy.
• Use Cotiviti audit tools to determine conclusions and issue audit letters.
• Meet productivity and quality standards per the performance plan.
• Identify new claim types and potential recoveries for consideration.
• Contribute to process improvements and special projects.

Skills

ICD-10 Coding

MS-DRG

AP-DRG

APR-DRG

Coding Guidelines

Word

Excel

TEAMS

Communication

Education

RN Nursing Degree

RHIA/RHIT

High School Diploma + 5+ years experience

Tools

Cotiviti auditing systems

MS-Office Suite

Job description

Cotiviti seeks a DRG Validation Auditor to perform cross claim clinical reviews and DRG validation for prepay and retrospective audits without medical records. You’ll audit inpatient claims, document results, and ensure coding accuracy and appropriate treatment settings.

The role is full-time with off-hour shifts (3 PM-11 PM or 11 PM-7 AM ET), weekends/holidays, and a base hourly rate of $45.67 with discretionary bonus eligibility.