Clinical Review QC Auditor
$68,566–$104,841 year
Remote · Fort Worth, Texas, United States or New York City, New York, United States
Job Summary
The Clinical Review QC Auditor will perform DRG validation and clinical coding reviews of medical records to ensure accurate billing. Key responsibilities include conducting audits, reviewing physician notes, verifying coding accuracy, and assisting the Quality Control team with appeals. Candidates should possess expert knowledge of ICD-10 codes, payer regulations, and coding guidelines, along with strong communication skills, critical thinking abilities, and attention to detail. A minimum of 2 years of DRG Quality Auditing experience is essential, along with a national coding certification.
Required Qualifications
- LVN or RN license in the state of employment preferred
- Required minimum of 2 year of recent DRG Quality Auditing experience in a hospital setting, or health plan
- National Coding Certification required through either AHIMA (preferred) or AAPC
- Extensive hands-on ICD-10 CM / PCS experience required
Desired Qualifications
- Experience in the OR, ICU, or ER as an RN highly preferred
- Proficient in both MS and APR DRG methodology preferred
Additional Requirements
- Equal Opportunity Employer
- Drug-free workplace compliance
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