Sr Auditor TL, Clinical Validation

The Judge Group; Wilton (CT); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare firm is seeking a Sr. Coding & Clinical Chart Validation Auditor to perform inpatient audits. The ideal candidate will possess clinical expertise and coding experience, ensuring accuracy in medical claims and documentation. This fully remote position offers a competitive hourly rate and requires a strong understanding of coding principles and compliance standards.

Qualifications

• 1.5+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
• Broad knowledge of medical claims billing/payment systems.

Responsibilities

• Claims Analysis and Auditing (Primary Role)
• Conduct medical chart coding reviews and audits.

Skills

Auditing

ICD-10 Coding

Communication

Education

Associate or Bachelor’s Degree in Nursing

Associate or Bachelor’s Degree in Health Information Management

Tools

Microsoft Office Suite

Job description

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Location: WILTON, CT, USA

Salary: $37.00 USD Hourly - $45.00 USD Hourly

Description

Judge Healthcare is seeking a Sr. Coding & Clinical Chart Validation (Inpatient) Auditor!!

Employment Type: Temp to Hire

Location: Fully Remote

Start Date: June 2nd

Training Hours: 8:00 AM – 4:00 PM EST

Work Hours : Full Time, 40 hrs.' per week in between 6a-6p EST

We are seeking an experienced Auditing Specialist to focus on Coding & Clinical Chart Validation for our Inpatient Audits . The ideal candidate possesses a combination of clinical expertise (nursing) and/or coding/auditing experience , particularly in Inpatient DRG/APR-DRG and episode of care disciplines. This role involves auditing inpatient claims and documenting results, with an emphasis on clinical review , coding accuracy , and evaluating treatment settings and services .

Key Responsibilities

• Claims Analysis and Auditing (Primary Role)
• Conduct medical chart coding reviews and audits, leveraging advanced ICD-10 coding principles, clinical guidelines, and industry knowledge.
• Perform comprehensive reviews of medical records and episodes of care independently.
• Effective Use of Audit Tools
• Utilize proprietary auditing systems to generate audit determinations and documentation.
• Demonstrate a high level of proficiency in audit tools.
• Meet Standards of Productivity
• Achieve and maintain production goals set by the audit operations team.
• Maintain Accuracy and Quality
• Ensure adherence to accuracy and quality benchmarks for auditing, claim validation, and documentation.
• Discover New Opportunities
• Identify claims outside of predefined concepts for potential recovery opportunities.
• Develop high-value concepts, process improvements, and innovative tools.
• Complete Assigned Duties
• Fulfill responsibilities outlined in the annual performance plan and contribute to special projects as needed.
  
  

Requirements

Education At least one of the following:

• Associate or Bachelor’s Degree in Nursing ( Active/Unrestricted License )
• Associate or Bachelor’s Degree in Health Information Management ( RHIA or RHIT )
  
  

Certifications At Least One Of The Following

• RHIA or RHIT

• CPC or COC
• Inpatient Coding Credential ( CCS, CIC, CDIP, or CCDS )
  
  

Experience

• 1.5+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.
• Broad knowledge of medical claims billing/payment systems, coding terminology, and payer reimbursement policies.
• Expertise in official coding guidelines, coding clinic determinations, CMS regulations, and compliance standards.
• Proficiency in Microsoft Office Suite (Word, Excel, Access, Teams) and other applications.
• Strong verbal and written communication skills.
  
  

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Contact: [e-mail]

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Hospitals and Health Care and Medical Practices

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