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United States
Remote only
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Validation Auditor (CVA) Auditor III based in the United States.
Put your clinical expertise to work in a fully remote role focused on improving the accuracy, consistency, and fairness of healthcare claims. As a Clinical Validation Auditor, you’ll review inpatient medical records and assess whether Diagnosis-Related Group (DRG) codes are supported by clinical documentation. Your work will help identify coding discrepancies, validate billing accuracy, and detect potential overpayments. You’ll apply your acute care nursing knowledge, clinical judgment, and understanding of coding guidelines to produce clear, evidence-based audit findings. Working independently within established productivity and quality standards, you’ll contribute to a collaborative healthcare analytics environment that values precision and continuous improvement. This opportunity is ideal for an experienced registered nurse looking to apply clinical expertise to healthcare auditing while enjoying the flexibility of remote work.
Review inpatient medical records to determine whether assigned Diagnosis-Related Group (DRG) codes are supported by the available clinical documentation.
Apply clinical expertise and coding validation knowledge to identify documentation discrepancies, coding inaccuracies, and potential overpayments.
Document audit findings clearly and professionally, providing evidence-based explanations and rationale for clinical validation decisions.
Use industry auditing and coding tools, such as 3M and Webstrat, to support record reviews and validation decisions; training may be provided when needed.
Work independently while consistently meeting established productivity, accuracy, and quality expectations.
Stay current with clinical guidelines, DRG requirements, coding rules, and relevant healthcare industry developments.
Apply attention to detail and consistency when evaluating clinical records and determining whether billed codes are appropriate.
Collaborate with team members to support reliable auditing practices and continuous quality improvement.
Participate in team meetings and occasional client onsite engagements, as required, with annual travel of up to 10%.
Active Registered Nurse (RN) license.
At least 5 years of acute care experience, preferably in a hospital setting.
Experience in DRG auditing or clinical coding validation is strongly preferred.
Additional certifications such as Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) are advantageous.
Knowledge of readmission reviews, including Potentially Preventable Readmissions (PPR), is a plus.
Strong understanding of inpatient clinical documentation and the ability to apply clinical judgment when reviewing coding and billing accuracy.
Excellent written communication skills, with the ability to explain clinical findings and audit decisions clearly, accurately, and professionally.
Strong attention to detail, consistency, and analytical problem-solving skills.
Proficiency with Microsoft Office applications, particularly Excel, Word, and OneNote.
Ability to work independently, organize time effectively, and maintain focus and productivity in a remote environment.
Comfortable managing deadlines, working under pressure, and balancing quality expectations with productivity requirements.
Strong interpersonal skills and a collaborative approach to working within a supportive, high-performing team.
Willingness to complete a brief coding or auditing assessment as part of the interview process, if required.
Annual salary: $60,100–$98,700, depending on experience, skills, and qualifications.
Fully remote work: Work remotely from within the United States.
Work-life flexibility: Enjoy the flexibility of a remote working arrangement.
Professional growth: Opportunity to deepen expertise in clinical validation, DRG auditing, and healthcare analytics.
Training and development: Training on relevant industry tools may be provided when needed.
Collaborative environment: Join a team focused on clinical accuracy, teamwork, and continuous improvement.
Healthcare benefits: A comprehensive benefits package is offered; specific coverage details are available through the employer’s careers and benefits information.
Compensation considerations: Final salary offers may depend on experience, qualifications, work location, internal pay equity, market conditions, and the responsibilities of the position.
Travel expectations: Up to 10% annual travel for team meetings and limited client onsite engagements.
