Associate Auditor Clinical Validation DRG in United States at Jobgether
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Job Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Associate Auditor Clinical Validation DRG in United States.
This role is an excellent opportunity for a detail-oriented healthcare professional with both clinical and coding expertise to contribute to payment integrity and claims accuracy. You will perform inpatient claim audits focused on coding validation, clinical appropriateness, DRG/APR-DRG accuracy, and treatment setting review. Working in a fully remote environment, you will use specialized audit tools and medical documentation to identify findings and support clear audit outcomes. The position combines analytical thinking, regulatory knowledge, and healthcare insight in a highly structured setting. You will collaborate with experienced audit teams while maintaining independent ownership of your workload. This is an ideal role for professionals seeking to apply nursing or coding experience in a high-impact, data-driven environment.
- Review and audit inpatient medical claims to validate coding accuracy, clinical documentation, DRG/APR-DRG assignment, and appropriateness of services rendered
- Analyze medical records and episodes of care using ICD-10 expertise, billing guidelines, and clinical standards to support audit conclusions
- Prepare clear, accurate documentation of findings and generate professional audit correspondence through internal systems
- Maintain productivity goals established by audit operations leadership while ensuring consistent quality and accuracy standards
- Identify emerging claim patterns, recovery opportunities, and areas for process or concept improvement
- Participate in required training programs, special projects, and continuous improvement initiatives
- Perform responsibilities independently while adhering to internal compliance, quality, and operational procedures
Requirements:
- Associate or bachelor’s degree in Nursing or Health Information Management, or active unrestricted LPN license
- Required active certification such as RHIA, RHIT, CPC, COC, CCS, CIC, CDIP, or CCDS
- Candidates without a current coding credential must obtain one within 6 months of hire
- Minimum 2 years of prior clinical, coding, auditing, CDI, or related healthcare experience preferred
- Strong knowledge of inpatient coding, ICD-10, claims review, and medical terminology
- Familiarity with provider billing guidelines and healthcare reimbursement systems preferred
- Proficiency with Microsoft Word, Excel, Teams, and related business tools
- Excellent written communication, analytical reasoning, and attention to detail
- Ability to work remotely with a dedicated secure workspace and reliable high-speed internet connection
Benefits:
- Competitive hourly compensation ranging from $31.25 to $38.46 based on experience, education, and qualifications
- Eligibility for discretionary bonus opportunities
- Overtime pay for eligible hours worked beyond 40 hours, where applicable
- Comprehensive healthcare coverage including medical, dental, vision, disability, and life insurance
- 401(k) savings plan to support long-term financial goals
- Paid family leave, 9 paid holidays annually, and 17–27 days of paid time off depending on tenure and level
- Fully remote work environment with structured onboarding and training support.