Senior Auditor, Clinical Validation (Inpatient Focus) - Temp to Hire

Posted on

April 2, 2025

Job Type

Contract

Role Type

Utilization Review

License

RN

State License

Compact / Multi-State

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Company Description

Job Description

Are you a seasoned CDI / DRG auditor with a strong clinical background and a passion for ensuring accuracy in medical claims? Our client is seeking a highly skilled Senior CDI / DRG Auditor to join their dynamic team, focusing on inpatient coding and clinical chart validation. This is a temp-to-hire opportunity offering a competitive salary based on experience. As a Senior CDI / DRG Auditor, you will play a critical role in analyzing and auditing inpatient claims, utilizing your clinical expertise and advanced coding knowledge to ensure accuracy and compliance. This role demands a deep understanding of ICD-10 coding, DRG/APR-DRG methodologies, and the ability to work independently to deliver high-quality audit results.

Requirements

Education: - Associate or bachelor’s degree in Nursing (with active/unrestricted license) OR - Associate or bachelor’s degree in Health Information Management (RHIA or RHIT required). Certification (One or more required and must be maintained): - RHIA, RHIT, CPC, COC or CRC - Inpatient coding credentials such as CCS, CIC, CDIP, or CCDS Experience: - 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG. - Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology. - Adherence to official coding guidelines and regulatory compliance (e.g., CMS standards). - Proficiency in Word, Access, Excel, TEAMS, and other applications. - Exceptional verbal and written communication skills.

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Responsibilities

Analyze and Audit Claims: Apply medical chart coding principles, clinical guidelines, and advanced ICD-10 coding expertise to review and audit medical records or episodes of care. Utilize industry knowledge to justify audit conclusions, working independently. Utilize Audit Tools Effectively: Proficiently operate proprietary systems to make audit determinations and draft audit letters. Meet Productivity Goals: Maintain production targets established by audit operations management. Ensure Accuracy and Quality: Achieve expected standards of accuracy and quality in claim identification and documentation, including letter writing. Identify Opportunities for Improvement: Suggest potential recoveries or improvements in auditing processes, concepts, and tools. Complete Assigned Responsibilities: Fulfill all duties outlined in the annual performance plan and complete special projects as assigned. Perform with or without Accommodation: Demonstrate adaptability and inclusivity to perform tasks effectively.

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