Clinical Validation Auditor RN

A company is looking for a Clinical Validation Auditor III. Key Responsibilities Conduct MS-DRG and/or APR-DRG clinical reviews to verify accuracy of DRG assignments Document audit results using clinical guidelines and coding rules Utilize proprietary tools to make audit determinations and manage claims workflow Required Qualifications Registered Nurse with an Associate's or Bachelor's degree 5+ years of acute care nursing experience, preferably with clinical or coding validation audit experience Experience with DRG retrospective overpayment identification auditing preferred Prior readmission auditing experience is desirable CCS, RHIA, or RHIT coding credentials are preferred

Mar 24, 2025 - 22:01

A company is looking for a Clinical Validation Auditor III. Key Responsibilities Conduct MS-DRG and/or APR-DRG clinical reviews to verify accuracy of DRG assignments Document audit results using clinical guidelines and coding rules Utilize proprietary tools to make audit determinations and manage claims workflow Required Qualifications Registered Nurse with an Associate's or Bachelor's degree 5+ years of acute care nursing experience, preferably with clinical or coding validation audit experience Experience with DRG retrospective overpayment identification auditing preferred Prior readmission auditing experience is desirable CCS, RHIA, or RHIT coding credentials are preferred