Auditor, DRG Validation – CMS Audits

Cotiviti

Auditor focusing on Coding & Clinical Chart Validation for Inpatient audits. Requires expertise in DRG Coding and claims auditing with strong attention to detail.

Posted 6/26/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $45,687 per hourWebsite

About the role

Key responsibilities & impact

Audits Inpatient DRG Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Inpatient DRG claims
Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues
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: Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)

Requirements

What you’ll need

Associate or bachelor’s degree Health Information Management (RHIA or RHIT)
High school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing
Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): 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 a 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, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates
Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
Requires working knowledge of and applicable industry-based standards
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

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Hard Skills & Tools

medical chart codingclaims auditingICD-9ICD-10MS-DRGAP-DRGAPR-DRGCPTHCPCScoding principles

Soft Skills

independent workattention to detailcommunication skillsquality assuranceproductivity management

Certifications

RHIARHITCPCCCSCICCDIPCCDS