Remote DRG Validation Auditor – Clinical & Coding Expert

Cotiviti; United States; On-site; USD 51,904 - 73,925; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) savings

Paid family leave

9 paid holidays per year

PTO

Job summary

Cotiviti is seeking a DRG Validation Auditor (Clinical & Coding) to focus on inpatient DRG validation. The role requires clinical nursing background and coding/audit experience, with responsibilities including chart reviews and documentation of audit conclusions.

The ideal candidate will have expert ICD-10 knowledge, familiarity with DRG/APR-DRG concepts, and strong proficiency in auditing tools and MS Office. Start dates: 8/31/2026 or 10/5/2026.

Qualifications

• 5 to 7+ years with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.
• Expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS.
• Adherence to official coding guidelines, coding clinic determinations and CMS requirements.

Responsibilities

• Analyzes and Audits Claims using ICD-10 coding principles and clinical guidelines.
• Uses Cotiviti auditing systems to reach audit determinations and draft audit letters.
• Meets or exceeds productivity standards set by audit operations management.
• Maintains accuracy and quality in auditing conclusions and documentation.
• Identifies new claim types and potential recoveries beyond standard concepts.
• Suggests process improvements and new tools for higher value audits.
• Completes responsibilities per annual Performance Plan and special projects.

Skills

ICD-10 coding

Clinical chart review

Auditing

Microsoft Excel

Microsoft Word

Microsoft Access

MS Teams

Communication skills

Education

Associate or bachelor's degree in nursing

Health Information Management degree (RHIA or RHIT)

High school diploma + 5+ years auditing experience

Tools

Cotiviti auditing systems

Claims billing systems

Job description

Cotiviti is seeking a DRG Validation Auditor (Clinical & Coding) to focus on inpatient DRG validation. The role requires clinical nursing background and coding/audit experience, with responsibilities including chart reviews and documentation of audit conclusions.

The ideal candidate will have expert ICD-10 knowledge, familiarity with DRG/APR-DRG concepts, and strong proficiency in auditing tools and MS Office. Start dates: 8/31/2026 or 10/5/2026.