Senior Auditor, Clinical Validation at The Judge Group Inc. in Boston, Massachusetts

Job Description:

Location: REMOTE

Salary: $37.00 USD Hourly - $44.00 USD Hourly

Description:

Senior Auditor, Clinical Validation (Inpatient Focus) - Temp to Hire




Job Summary:



Are you a seasoned CDI / DRG auditor with a strong clinical background and a passion for ensuring accuracy in medical claims? Our client is seeking a highly skilled Senior CDI / DRG Auditor to join their dynamic team, focusing on inpatient coding and clinical chart validation. This is a temp-to-hire opportunity offering a competitive salary based on experience.


As a Senior CDI / DRG Auditor, you will play a critical role in analyzing and auditing inpatient claims, utilizing your clinical expertise and advanced coding knowledge to ensure accuracy and compliance. This role demands a deep understanding of ICD-10 coding, DRG/APR-DRG methodologies, and the ability to work independently to deliver high-quality audit results.



Responsibilities:



Analyze and Audit Claims:


• Apply medical chart coding principles, clinical guidelines, and advanced ICD-10 coding expertise to review and audit medical records or episodes of care.


• Utilize industry knowledge to justify audit conclusions, working independently.


Utilize Audit Tools Effectively:


• Proficiently operate proprietary systems to make audit determinations and draft audit letters.


Meet Productivity Goals:


• Maintain production targets established by audit operations management.


Ensure Accuracy and Quality:


• Achieve expected standards of accuracy and quality in claim identification and documentation, including letter writing.


Identify Opportunities for Improvement:


• Suggest potential recoveries or improvements in auditing processes, concepts, and tools.


Complete Assigned Responsibilities:


• Fulfill all duties outlined in the annual performance plan and complete special projects as assigned.


Perform with or without Accommodation:


• Demonstrate adaptability and inclusivity to perform tasks effectively.



Qualifications:



Education:


- Associate or bachelor's degree in Nursing (with active/unrestricted license) OR


- Associate or bachelor's degree in Health Information Management (RHIA or RHIT required).


Certification (One or more required and must be maintained):


- RHIA, RHIT, CPC, COC or CRC


- Inpatient coding credentials such as CCS, CIC, CDIP, or CCDS


Experience:


- 5-7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.


- Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.


- Adherence to official coding guidelines and regulatory compliance (e.g., CMS standards).


- Proficiency in Word, Access, Excel, TEAMS, and other applications.


- Exceptional verbal and written communication skills.



Job Details:



Title: Senior Auditor, Clinical Validation


Type: Temp to Hire


Pay: Dependent upon experience



Schedule:



- Training hours: Eastern Time (8 AM - 4 PM).


- Post-training: Start between 6 AM and 6 PM EST, ending no later than 6 PM EST.



Location: Fully Remote

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Contact: lbraccio@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now