Sr Auditor TL, Clinical Validation at The Judge Group Inc. in Houston, Texas

Job Description:

Location: Houston, TX

Salary: $38.00 USD Hourly - $44.00 USD Hourly

Description: Our client is currently seeking a Sr Auditor TL, Clinical Validation



Job Overview:



We are seeking a highly skilled Inpatient Auditor to specialize in Coding & Clinical Chart Validation for Inpatient DRG/APR-DRG and/or episode of care audits. This role requires a dual background in clinical nursing and coding/auditing to ensure accurate assessment of inpatient claims, documentation, coding accuracy, and treatment appropriateness.



Key Responsibilities:

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  Claims Analysis and Auditing: Perform independent audits by applying advanced ICD-10 coding expertise, clinical guidelines, and industry standards. Tasks may include medical record or episode of care reviews.
  
  


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  Audit Tools Utilization: Operate proprietary auditing systems to make determinations and generate reports with proficiency.
  
  


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  Productivity Standards: Meet or exceed production goals set by audit operations management.
  
  


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  Accuracy & Quality Standards: Maintain high accuracy in claim identification, coding documentation, and audit letters.
  
  


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  New Claim Identification: Propose new claim types and develop innovative concepts or process improvements.
  
  

Additional Duties:

• Complete responsibilities as outlined in the annual performance plan.
  
  


• Participate in special projects as assigned.
  
  


• Perform duties with or without reasonable accommodations.
  
  

Qualifications:




Education (Required):

• Associate or bachelor's degree in Nursing (active/unrestricted license) or
  
  
  


• Associate or bachelor's degree in Health Information Management (RHIA or RHIT)
  
  

Certifications (Required):

• RHIA, RHIT, CPC, COC or
  
  
  


• Inpatient Coding Credentials: CCS, CIC, CDIP, CCDS
  
  

Experience:

• 5-7+ years in ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG coding, and billing/payment systems.
  
  


• Expert in official coding guidelines, CMS compliance, DRG/APR-DRG methodologies, and coding terminologies (ICD-10, CPT, HCPCS).
  
  


• Proficient in Microsoft Office applications (Word, Excel, Access, Teams).
  
  


• Exceptional written and verbal communication skills.
  
  

Work Schedule:

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  Training Hours: 8 AM-4 PM (Eastern Time)
  
  


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  Work Hours: 8 AM-4:30 PM (flexibility up to 6 PM with adjusted start time)
  
  

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Contact: sballakur@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now