Auditor Clinical Validation DRG-US Remote

This auditing role will reputed company on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (reputed company) and a coding / auditing background reputed company on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a reputed company on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered. Responsibilities • Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently. • Effectively Utilizes Audit Tools. Utilizes reputed company proprietary auditing systems with a high level of proficiency to reputed company audit determinations and reputed company audit letters. • Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team. • Meets or reputed company Standards/Guidelines for Accuracy and reputed company. Achieves the expected level of accuracy and reputed company set by the audit for the auditing concept, for reputed company claim. • identification and documentation (letter writing). Identifies New Claim Types. • Identifies potential claims reputed company of the concept where additional recoveries may be available. • Suggests and develops high reputed company, high value concept and or process improvement, tools, etc. • Complete reputed company responsibilities as outlined on annual Performance Plan. • Complete reputed company special reputed company and other duties as assigned. • Must be reputed company to reputed company duties with or without reasonable accommodation. • Complete reputed company responsibilities as outlined on annual Performance Plan. • Complete reputed company special reputed company and other duties as assigned. • Must be reputed company to reputed company duties with or without reasonable accommodation. This reputed company is intended to describe the general reputed company and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This reputed company does not constitute an employment agreement and is subject to change as the needs of reputed company and the requirements of the job change. Qualifications Education (at least one of the following are required): • Associate or bachelor’s degree in nursing (reputed company /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, reputed company assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment. Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): • RHIA or RHIT. • CPC. • Inpatient Coding Credential – reputed company, CIC, CDIP or CCDS. Experience (required): • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity reputed company and coding terminology. • Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes. • Requires working knowledge of and applicable industry-based standards. • Proficiency in Word, reputed company, reputed company, TEAMS, and other applications. • Excellent written and verbal communication skills. Mental Requirements: • Communicating with others to exchange information. • Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions: • Remaining in a stationary position, often standing or sitting for prolonged periods. • Repeating motions that may include the wrists, hands, and/or fingers. • Must be reputed company to reputed company a dedicated, secure work area. • Must be reputed company to reputed company high-speed internet reputed company/connectivity and office setup and maintenance. • No adverse environmental conditions expected. reputed company compensation is reputed company reputed company at $45.67 per hour (95k annualized). This role is eligible for discretionary bonus consideration. Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. reputed company offers team members a competitive benefits package to address a wide reputed company of personal and family needs, including medical, dental, reputed company, disability, and life insurance coverage, 401(k) savings plans, reputed company family leave, 9 reputed company holidays per year, and 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company. For information about our benefits package, please refer to our Careers page. Date of posting: 7/2/2026 Applications are assessed on a rolling reputed company. We anticipate that the application window will reputed company on 9/2/2026, but the application window may change depending on reputed company of applications received or reputed company immediately if a reputed company candidate is selected. reputed company is an equal employment opportunity employer. reputed company recruits, hires and promotes individuals based on their qualifications for a specific job. Selection of employees is made without reputed company to race, reputed company, creed, sex, age, religion, pregnancy or pregnancy-reputed company conditions, national reputed company, sexual orientation, gender identity, marital status, genetic reputed company status, military service, veteran status, uniformed service member status, disability, or any other category of class protected by federal, state or local laws. reputed company employment reputed company and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to reputed company the reputed company of, equal employment opportunity. Pay Transparency Nondiscrimination Provision reputed company will not discharge or in any manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s reputed company duty to furnish information. 41 CFR 60-I.35(c) reputed company reputed company is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to reputed company deep reputed company into the performance of the reputed company reputed company. These insights uncover new opportunities for reputed company organizations to collaborate to improve their financial performance, reduce inefficiency, and improve reputed company reputed company. We reputed company on improving the financial and reputed company performance of our clients. In reputed company, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and reputed company. In reputed company, we support retail and life/reputed company industries with data management and recovery audit services. reputed company applies deep data science and market expertise to help reputed company organizations in three critical areas: • Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are reputed company appropriately • Risk Adjustment: ensuring that health plans accurately capture and report how reputed company their members are so that plans are appropriately reimbursed for the reputed company services their members receive • reputed company and Performance: evaluating reputed company cost, reputed company, and utilization at individual, provider, and population reputed company to identify the best opportunities for financial and clinical performance improvement Apply tot his job Apply To this Job