California Licensed Clinical Audit SME

A company is looking for a Senior Clinical Audit Subject Matter Expert. Key Responsibilities Conduct comprehensive Clinical DRG validation audits and reviews for compliance with payer policies and regulations Serve as a clinical expert for product development and assist in developing clinical policies Perform quality assessments and identify training opportunities based on audit outcomes Required Qualifications, Training, and Education Associates or Bachelor's degree in Nursing 10+ years of experience in claims auditing, quality assurance, or recovery auditing Certifications: RHIA or RHIT, CDIP or CCDS (required), CCS or CIC (preferred), RN with current licensure (required) 5-10 years of nursing experience in a facility setting Experience with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG in a payer or vendor setting

Mar 20, 2025 - 00:38

A company is looking for a Senior Clinical Audit Subject Matter Expert. Key Responsibilities Conduct comprehensive Clinical DRG validation audits and reviews for compliance with payer policies and regulations Serve as a clinical expert for product development and assist in developing clinical policies Perform quality assessments and identify training opportunities based on audit outcomes Required Qualifications, Training, and Education Associates or Bachelor's degree in Nursing 10+ years of experience in claims auditing, quality assurance, or recovery auditing Certifications: RHIA or RHIT, CDIP or CCDS (required), CCS or CIC (preferred), RN with current licensure (required) 5-10 years of nursing experience in a facility setting Experience with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG in a payer or vendor setting