Senior DRG Validation Auditor - Clinical & Coding (Remote)

Cotiviti

Idaho

On-site

USD 85,500 - 104,500

Full time

14 days+

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Job summary

Cotiviti is seeking an experienced auditor focused on inpatient coding validation and DRG accuracy. The role combines clinical nursing insight with coding expertise to audit inpatient claims and document results.

The ideal candidate will bring 5–7+ years in ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG, strong CMS guideline knowledge, and proficiency with auditing tools and Microsoft Office. Remote options are noted in the posting.

Qualifications

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.

Responsibilities

Analyzes and audits claims with ICD-10 coding principles and clinical guidelines to substantiate conclusions.
Utilizes Cotiviti proprietary auditing systems to make audit determinations and generate audit letters.
Meets or exceeds productivity standards set by audit management.
Meets or exceeds accuracy and quality standards for auditing concepts, valid claims, identification and documentation.
Identifies new claim types and potential recoveries; contributes to process improvements.