Auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed
Analyzing and auditing claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities
Utilizing audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters
Maintaining accuracy and quality standards as established by audit management
Identifying potential documentation and coding errors by recognizing aberrant coding and documentation patterns
Suggesting and developing high quality, high value, concept and or process improvement and efficiency recommendations

Current, active, unrestricted Registered Nurse license in applicable state(s)
Minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement
Minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG
Preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC), Inpatient Coding Credential (CCS or CIC)

Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

About this role