Clinical Validation Auditor (CVA) Auditor.

Accountabilities

• 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%.

Requirements

• 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.

Benefits

• 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.