Clinical Validation Auditor III

What You’ll Be Doing:

• Review inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentation.
• Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
• Document your findings in clear, professional language that explains the rationale behind your review.
• Use industry tools like 3M or Webstrat (don’t worry—we’ll train you if needed!) to support your decisions.
• Work independently while meeting productivity and quality goals.
• Stay up to date with clinical guidelines, DRG rules, and industry trends.

What We’re Looking For:

• A Registered Nurse (RN) with an active license.
• 5+ years of acute care experience (hospital setting preferred).
• Experience in DRG audits or coding validation is a big plus!
• Bonus points if you have certifications like CCS, RHIA, or RHIT.
• Knowledge of readmission reviews (PPR) is also a plus.