Clinical DRG Validation Auditor (RN, CCS Required)

Location: Remote (must live in NJ, PA, NY) Job Type: Full‑time
6 month contract with possibility to converting to perm

Job Summary

The Hospital Billing & Coding Audit Nurse is responsible for leading on‑site and desk audits of hospital billing and coding practices. This role develops audit forms, identifies trends, designs audit protocols, and completes DRG validation, per‑diem reviews, bill verification, and credit balance audits. The position also provides guidance on ICD‑10‑CM, DRG assignment, and payment auditing to internal and external stakeholders.

Key Responsibilities

• Billing Discrepancy Review — Identify and present billing errors found during audits and coordinate referrals for improper claim payments.

• Error Trend Analysis — Identify documentation or billing trends related to coding errors or contract misinterpretation.

• Audit Reporting — Compile audit statistics and prepare reports for accounts, regulatory agencies, and internal teams.

• Process Improvement — Review and update audit processes to align with new clinical data review methods and cost‑containment initiatives.

• Staff Training — Train new team members on audit procedures and departmental workflows.

• Special Projects — Complete special assignments as directed by management.

• Regulatory Compliance — Demonstrate knowledge of laws, regulations, and policies relevant to billing, coding, and audit operations.

Qualifications

Required

• Active RN license and CCS certification.

• Minimum 3 years of experience in a medical records department within an acute care hospital or similar healthcare facility.

• Experience with DRG validation, ICD‑10‑CM training, and coding education.

• Strong computer skills, including Microsoft Excel, Word, and PowerPoint.

Preferred

• Bachelor’s degree in Health Information Management, or equivalent experience.

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