Auditor Clinical Validation DRG

About the role

The ideal candidate will be an Auditor Clinical Validation DRG with expertise in financial analysis and regulatory compliance. This role requires strong analytical skills, attention to detail, and the ability to work independently and collaboratively.

Responsibilities

• Conduct clinical validation of Diagnosis Related Groups (DRGs) using AI tools to ensure accuracy and consistency.
• Analyze financial data to identify trends and discrepancies that require further investigation.
• Collaborate with cross-functional teams to develop and implement policies and procedures related to DRG validation.
• Prepare and present findings to senior management and stakeholders.
• Ensure all DRG validations comply with relevant healthcare regulations and standards.

Requirements

• Bachelor's degree in Finance, Healthcare Administration, or a related field.
• Minimum 5 years of experience in clinical validation or financial auditing.
• Experience with DRG systems and regulatory frameworks.
• Strong proficiency in Microsoft Office Suite, particularly Excel for data analysis.
• Excellent communication and interpersonal skills.
• Ability to work in a fast-paced environment and meet deadlines.

Qualifications

• Knowledge of healthcare reimbursement models and payment methodologies.
• Experience with data analytics and statistical methods.
• Understanding of healthcare regulations and compliance requirements.
• Ability to manage multiple projects simultaneously.

Skills

• Proficiency in Python or R for data manipulation and analysis.
• Experience with clinical coding and documentation.
• Strong problem-solving and critical thinking skills.
• Excellent written and verbal communication skills.

Benefits

• Competitive salary commensurate with experience.
• Flexible remote work options.
• Professional development opportunities.
• Health insurance coverage.
• Employee assistance program.

Pay

• $80,000 - $100,000 annually.

Schedule

• Full-time position.