Senior Inpatient DRG Auditor & Clinical Validation

Cotiviti; United States; On-site; USD 86,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) plan

Paid family leave

9 holidays per year

PTO 17-27 days

Job summary

Cotiviti is seeking an experienced auditing professional to focus on Coding & Clinical Chart Validation for Inpatient audits. The ideal candidate will combine nursing clinical background with strong ICD-10/MS-DRG auditing expertise to evaluate inpatient claims and document audit outcomes.

The role emphasizes accuracy, adherence to guidelines, and the ability to use Cotiviti auditing tools to support findings, letters, and potential process improvements.

Qualifications

• Active nursing license (RN) or RHIA/RHIT credentials are preferred.
• 5+ years in ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG auditing.
• Proficient in CMS coding guidelines and rules.
• Proficient in Word, Excel, TEAMS and related tools.
• Excellent written and verbal communication skills.

Responsibilities

• Audits inpatient claims and documents audit results.
• Uses Cotiviti audit systems to make determinations and issue audit letters.
• Maintains productivity and quality standards.
• Identifies new claim types and potential recoveries.
• Participates in performance plans and special projects.

Skills

Excellent communication

Microsoft Word

Microsoft Excel

TEAMS

Education

Nursing degree (RN)

Health Information Management degree (RHIA/RHIT)

High school diploma + 5+ years claims auditing

Tools

Microsoft TEAMS

Job description

Cotiviti is seeking an experienced auditing professional to focus on Coding & Clinical Chart Validation for Inpatient audits. The ideal candidate will combine nursing clinical background with strong ICD-10/MS-DRG auditing expertise to evaluate inpatient claims and document audit outcomes.

The role emphasizes accuracy, adherence to guidelines, and the ability to use Cotiviti auditing tools to support findings, letters, and potential process improvements.