Clinical Validation Auditor
Company: VirtualVocations
Location: Jersey City
Posted on: October 16, 2024
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Job Description:
A company is looking for a Clinical Validation Auditor III to
conduct audits of inpatient medical records and validate DRG
codes.
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 encoder systems to generate audit
rationales 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 in DRG retrospective overpayment identification auditing
is preferred
Prior readmission (PPR) auditing experience is preferred
CCS, RHIA, or RHIT coding credentials are preferred
Keywords: VirtualVocations, West Hartford , Clinical Validation Auditor, Healthcare , Jersey City, Connecticut
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