Clinical Validation Auditor

Company: Change Healthcare
Location: Lombard
Posted on: January 26, 2023

Job Description:

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.Work Location:

• Fully Remote - U.S.Position:The Clinical Review Auditor is responsible for performing accurate Clinical Validation Audits of inpatient medical records to validate diagnoses. The Clinical Review Auditor may also screen claim data and respond to provider appeals. The Clinical Review Auditor works closely with DRG Analysts and provides clinical insight for DRG validations as necessary.Core Responsibilities:
  • Performs Clinical Validation Appeal Audits by applying extensive knowledge of clinical criteria and guidelines accurately and objectively while maintaining productivity targets.
  • Demonstrates ability to appropriately apply clinical criteria to a variety of claims scenarios and effectively utilize audit tools to maximize savings.
  • Demonstrates ability to research clinical criteria and evaluate it for accuracy, quality, and to ensure it meets accepted standards of medical practice.
  • Works independently to meet or exceed productivity and accuracy goals.
  • Communicates audit findings with excellent grammar and writing skills.
  • Performs appeal reviews and responds to provider disputes for Clinical Validation Audits.
  • Screens claims data including MS-DRG, AP-DRG, and APR-DRG data.
  • Interfaces with Physician advisors, Coders, and other members of the audit team.
  • Maintains current knowledge of clinical guidelines, reimbursement trends, and client expectations.
  • Demonstrates commitment to Change Healthcare core values.Requirements:
    • An active and unrestricted RN license
    • 3 years of clinical nursing experience in the inpatient setting
    • Clinical validation audit experience
    • 3 years of inpatient coding experience including documented competency in ICD-10; or 3 years of inpatient CDI experience; or equivalent experience
    • Ability to perform in-depth analysis of clinical documentation relating to diagnoses
    • Proficiency with MS Office along with good ability to learn new systems
    • Excellent spoken and written communication skills
    • Excellent analytical skills
    • High level organizational and prioritization skills with the ability to manage multiple, concurrent projects and tasks effectivelyPreferred Qualifications:
      • Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) a plus
      • Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) a plus
      • Degree from accredited college or university a plusWorking Conditions/Physical Requirements:
        • General office demandsTravel:
          • No travelUnique Benefits*:
            • Flexible work environments
            • Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
            • Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
            • Employee wellbeing programs and generous health plans
            • Educational assistance programs
            • US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
            • Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
            • Learn more at
            • *Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.Diversity and Inclusion:
              • At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
              • Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at Feeling Inspired? Ready to #MakeAChange? Apply today!#li-remoteNew York and New Jersey Residents Only: The salary range for New York City, NY and Westchester County, NY is $77,280 - $134,400. The salary range for Ithaca, NY is $67,200- $112,000. The salary range for Jersey City, NJ is $80,640 - $134,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, Change Healthcare offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with Change Healthcare, you'll find a far-reaching choice of benefits and incentives.Diversity, Equity & Inclusion:---At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.---Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at Feeling Inspired? Ready to #MakeAChange? Apply today!COVID Vaccination RequirementsWe remain committed to doing our part to ensure the health, safety and well-being of our team members and our communities. As such, some individuals may be required to disclose COVID-19 vaccination status prior to or during employment. Certain roles may require COVID-19 vaccination and/or testing as a condition of employment. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.Equal Opportunity/Affirmative Action Statement Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at and the supplemental information at .If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.comwith "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.Click here to view our pay transparency nondiscrimination policy.California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood.Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Keywords: Change Healthcare, Lombard , Clinical Validation Auditor, Healthcare , Lombard, Illinois