DRG Validation Auditor – Off Hours Work

Cotiviti

DRG Validation Auditor performing clinical reviews and audits for prepay and retrospective claims at an innovative healthcare analytics company. Focusing on accuracy, treatment appropriateness, and coding compliance while working off-hour shifts.

Posted 6/19/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $45,667 per hourWebsite

About the role

Key responsibilities & impact

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 Exceeds Standards/Guidelines for Accuracy and Quality
Identifies New Claim Types
Suggests and develops high quality, high value concepts and or process improvement tools

Requirements

What you’ll need

Associate or bachelor’s degree in nursing (active/unrestricted license)
Associate or bachelor’s degree in Health Information Management (RHIA or RHIT)
High school diploma or GED plus equivalent experience of 5+ years in claims auditing, ideally in a DRG / Clinical Validation Audit setting or a hospital environment
Coding/CDI Certification (at least one of the following are required): RHIA or RHIT, CPC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, and medical necessity criteria
Expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
Proficiency in Word, Access, Excel, TEAMS, and other applications
Excellent written and verbal communication skills

Benefits

Comp & perks

Medical, dental, vision, disability, and life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

ICD-10 codingICD-9 codingDRGAPR-DRGCPTHCPCS codesclaims auditingmedical chart codingclinical validationmedical claims billing

Soft Skills

independent workcommunication skillsprocess improvementanalytical skillsattention to detailproductivity standardsaccuracy standardsquality standards

Certifications

RHIARHITCPCCCSCICCDIPCCDS