DRG Validation Auditor (Clinical & Coding)
Cotiviti · United States
- Hybrid
- Full-time
- $95,000 / year
- United States
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Job highlights
- Audit inpatient claims for coding and clinical accuracy.
- Utilize proprietary auditing systems for claim review.
- Meet productivity and quality performance standards.
- Requires clinical and coding expertise in DRG validation.
- Remote position with competitive salary and benefits.
About the role
DRG Validation Auditor (Clinical & Coding)
Cotiviti is seeking a skilled DRG Validation Auditor with a combined clinical and coding background to join our team. This role focuses on auditing inpatient claims, specifically Inpatient DRG/APR-DRG, ensuring accuracy in clinical review, coding, and treatment setting appropriateness.
Key Responsibilities
- Analyze and audit claims, integrating medical chart coding principles, clinical guidelines, and objectivity.
- Utilize Cotiviti's proprietary auditing systems for audit determinations and letter generation.
- Meet or exceed productivity, accuracy, and quality standards set by the audit operations team.
- Identify potential claim recovery opportunities and suggest process improvements.
- Complete all assigned responsibilities, special projects, and duties.
Qualifications
- Education: Associate or bachelor’s degree in nursing (active license), Health Information Management (RHIA or RHIT), or High school diploma/GED with 5+ years of relevant experience.
- Coding/CDI Certification: RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS required.
- Experience: 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG, medical claims billing systems, reimbursement policies, and coding terminology.
- Expert coding knowledge in DRG, APRDRG, ICD-10, CPT, and HCPCS codes.
- Proficiency in Microsoft Office Suite (Word, Access, Excel, TEAMS).
- Excellent written and verbal communication skills.
Work Environment
- This is a remote position requiring a dedicated, secure work area with high-speed internet access.
- The role involves stationary tasks, often sitting for prolonged periods, and repetitive hand/wrist motions.
Compensation and Benefits
- Base compensation: $45.67 per hour ($95k annualized).
- Eligible for discretionary bonus and overtime pay.
- Comprehensive benefits package including medical, dental, vision, 401(k), PTO, and paid holidays.
Key Skills/Competency
- DRG Validation
- Clinical Auditing
- Coding Accuracy
- Inpatient Coding
- ICD-10CM
- APR-DRG
- MS-DRG
- Claims Analysis
- Medical Necessity
- Regulatory Compliance
Skills & topics
- DRG Validation Auditor
- Clinical Auditor
- Coding Auditor
- Inpatient Coding
- DRG
- APR-DRG
- ICD-10
- Healthcare Auditing
- Revenue Cycle
- Medical Auditing
How to get hired
- Tailor your resume: Highlight your clinical nursing background and ICD-10/DRG coding certification. Quantify achievements in claims auditing and quality assurance.
- Craft a compelling cover letter: Directly address how your experience with inpatient DRG/APR-DRG aligns with Cotiviti's needs. Emphasize your ability to work independently and meet productivity standards.
- Prepare for technical questions: Be ready to discuss your expertise in ICD-10CM, MS-DRG, AP-DRG, and APR-DRG, along with clinical guidelines and payer policies.
- Showcase your communication skills: During the interview, demonstrate excellent written and verbal communication by clearly articulating your audit findings and rationale.
- Understand Cotiviti: Research Cotiviti's mission, values, and recent work in healthcare analytics and payment accuracy solutions.
Technical preparation
Master ICD-10CM, MS-DRG, AP-DRG, APR-DRG coding.,Review clinical guidelines and payer policies thoroughly.,Practice using audit tools and proprietary systems.,Understand medical necessity criteria for all services.
Behavioral questions
Describe a complex audit you handled.,How do you ensure coding accuracy?,How do you manage productivity goals?,How do you handle disagreements on audit findings?
Frequently asked questions
- What is the work arrangement for the DRG Validation Auditor role at Cotiviti?
- The DRG Validation Auditor position at Cotiviti is a remote role, requiring you to provide a dedicated, secure work area with high-speed internet access. This allows for flexibility while maintaining productivity and data security.
- What are the minimum education and certification requirements for this Cotiviti auditing position?
- To qualify for the DRG Validation Auditor role, you need at least an Associate or Bachelor's degree in nursing with an active license, or a degree in Health Information Management (RHIA/RHIT). Alternatively, a high school diploma/GED with 5+ years of relevant experience is accepted. A required coding/CDI certification like RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS must be maintained.
- How much experience is needed to be considered for the DRG Validation Auditor job at Cotiviti?
- Cotiviti requires 5 to 7+ years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG. This experience should include a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
- What is the hourly pay rate for the DRG Validation Auditor at Cotiviti?
- The base compensation for the DRG Validation Auditor position is $45.67 per hour, which annualizes to approximately $95,000. This role is also eligible for discretionary bonus consideration and overtime pay for hours worked beyond 40 in a week.
- Does Cotiviti offer benefits for the DRG Validation Auditor position?
- Yes, Cotiviti offers a comprehensive benefits package for its team members, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays, and 17-27 days of Paid Time Off (PTO) annually, depending on your level and tenure with the company.
- How are applications assessed for the DRG Validation Auditor role at Cotiviti?
- Cotiviti assesses applications on a rolling basis for the DRG Validation Auditor position. This means applications are reviewed as they are received, and the application window may close early if a qualified candidate is selected, so it's advisable to apply promptly.