Auditor Clinical Validation, DRG

Cotiviti

Clinical DRG auditor validating inpatient claims, coding accuracy, and treatment settings for Cotiviti’s healthcare payment solutions. Conducting audits and identifying additional recovery opportunities remotely.

Posted 8/21/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $46 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates advanced expertise in ICD-10 coding, clinical chart validation, and medical audit processes, ensuring compliance with coding guidelines and regulatory standards. Proficient in utilizing auditing systems and tools to enhance claim identification and recovery efforts.

Highest-signal resume keywords

ICD-10 Coding ExpertiseClaims Auditing ExperienceRHIA/RHIT CertificationDRG KnowledgeMedical Claims Billing Knowledge

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

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

Hard Skills

ICD-9/10-CMMS-DRGAP-DRGAPR-DRGCPT CodingHCPCS CodingCoding Guidelines AdherenceQuality AssuranceClaim DocumentationAudit Determination

Soft Skills

Excellent Written CommunicationExcellent Verbal Communication

Tools & Technologies

Cotiviti Auditing SystemsMicrosoft WordMicrosoft AccessMicrosoft ExcelMicrosoft Teams

Certifications & Qualifications

RHIARHITCPCCCSCICCDIPCCDS

Industry Keywords

Medical Necessity CriteriaPayer Reimbursement PoliciesProvider Billing GuidelinesCoding TerminologyRegulatory Compliance

About the role

Key responsibilities & impact

Audit inpatient claims with a focus on coding and clinical chart validation
Integrate medical chart coding principles, clinical guidelines, and objectivity into medical audit activities
Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate audit conclusions
Perform work independently
Use Cotiviti proprietary auditing systems to make audit determinations and generate audit letters
Meet productivity goals set by audit operations management
Meet accuracy and quality standards for valid claim identification and documentation, including letter writing
Identify new claim types and potential claims outside the audit concept where additional recoveries may be available
Suggest and develop high-quality, high-value concepts, process improvements, and tools
Complete annual Performance Plan responsibilities, special projects, and other assigned duties

Requirements

What you’ll need

Associate or bachelor’s degree in nursing with an active/unrestricted license; or associate or bachelor’s degree in Health Information Management with RHIA or RHIT; or high school diploma/GED plus 5+ years’ equivalent experience in claims auditing, quality assurance, or recovery auditing
At least one required and maintained coding/CDI certification: RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS
5 to 7+ years of experience working with ICD-9/10-CM, 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, Coding Clinic determinations, CMS and other regulatory compliance guidelines and mandates
Expert knowledge of DRG, APR-DRG, ICD-10, CPT, and HCPCS codes
Working knowledge of applicable industry-based standards
Proficiency in Word, Access, Excel, Teams, and other applications
Excellent written and verbal communication skills
Ability to perform duties with or without reasonable accommodation
Ability to provide a dedicated, secure work area
Ability to provide high-speed internet access/connectivity and office setup and maintenance
Ability to remain stationary, often standing or sitting for prolonged periods, and repeat motions involving wrists, hands, and/or fingers

Benefits

Comp & perks

Discretionary bonus consideration
Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plan
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
Remote work arrangement
Dedicated, secure work area and high-speed internet/office setup provided by the employee