State Licensed Clinical DRG Auditor
virtual vocationsDenver (CO)
State Licensed Clinical DRG Auditor
Posted today
virtual vocationsDenver (CO)
SENIORITY
Senior
About the role
Seeking an experienced State Licensed Clinical DRG Auditor, the full-time remote position will perform inpatient Diagnosis-Related Group (DRG) validation audits and detailed clinical reviews of medical records and claims to improve payment accuracy and support audit automation.
Key responsibilities:
Conduct comprehensive clinical DRG audits on inpatient claims, validating diagnoses and procedures according to CMS guidelines
Produce clear audit findings and document determinations in the audit platform
Collaborate with cross-functional teams to provide clinical insights that enhance audit logic and processes
Required qualifications:
Active Registered Nurse (RN) license
3+ years of experience in clinical DRG validation, inpatient clinical review, or DRG auditing
Strong ability to interpret inpatient medical records and assess clinical validity
Experience applying clinical judgment in reimbursement or audit contexts
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