State Licensed Clinical Auditor

A company is looking for a Clinical Validation Auditor III. Key Responsibilities Conduct MS-DRG and/or APR-DRG clinical reviews to verify DRG assignment accuracy Document audit results using clinical guidelines and coding rules Utilize proprietary tools and workflow systems to make audit determinations and manage claims 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 is preferred Prior readmission auditing experience is preferred 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 DRG assignment accuracy Document audit results using clinical guidelines and coding rules Utilize proprietary tools and workflow systems to make audit determinations and manage claims 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 is preferred Prior readmission auditing experience is preferred CCS, RHIA, or RHIT coding credentials are preferred