DRG Validation Auditor - Off Hours Work (2nd, 3rd, or weekend shift work)

Overview This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this role will be doing DRG Validation for our prepay and retrospective audits and making determinations without a medical record. The ideal candidate for this position needs to have both a strong inpatient HIM/coding background and an understanding of clinical validation. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting, services delivered and patient history. This is a Full-Time role, scheduled to work an off-hour shift from either 3 PM-11 PM or 11 PM-7 AM ET, including weekends & holidays. (No PT or PRN availability) Responsibilities Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently. Effectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters. Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team. Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accu