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Clinical Validation Auditor

Job ID R28272

Location

Lombard, Illinois, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, Oregon, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Oklahoma, Alabama, Arizona, Arkansas, California, Connecticut, Washington, DC, Delaware, Florida, Georgia, Idaho, Illinois, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio Lombard, Illinois, United States of America; VIRTUAL, Pennsylvania, United States of America; VIRTUAL, Rhode Island, United States of America; VIRTUAL, South Carolina, United States of America; VIRTUAL, South Dakota, United States of America; VIRTUAL, Tennessee, United States of America; VIRTUAL, Texas, United States of America; VIRTUAL, Utah, United States of America; VIRTUAL, Vermont, United States of America; VIRTUAL, Virginia, United States of America; VIRTUAL, Washington, United States of America; VIRTUAL, West Virginia, United States of America; VIRTUAL, Wisconsin, United States of America; VIRTUAL, Wyoming, United States of America; VIRTUAL, Massachusetts, United States of America; VIRTUAL, Michigan, United States of America; VIRTUAL, Minnesota, United States of America; VIRTUAL, Mississippi, United States of America; VIRTUAL, Missouri, United States of America; VIRTUAL, Montana, United States of America; VIRTUAL, Nebraska, United States of America; VIRTUAL, Nevada, United States of America; VIRTUAL, New Hampshire, United States of America; VIRTUAL, Oregon, United States of America; VIRTUAL, Indiana, United States of America; VIRTUAL, Iowa, United States of America; VIRTUAL, Kansas, United States of America; VIRTUAL, Kentucky, United States of America; VIRTUAL, Louisiana, United States of America; VIRTUAL, Maine, United States of America; VIRTUAL, Maryland, United States of America; VIRTUAL, Oklahoma, United States of America; VIRTUAL, Alabama, United States of America; VIRTUAL, Arizona, United States of America; VIRTUAL, Arkansas, United States of America; VIRTUAL, California, United States of America; VIRTUAL, Connecticut, United States of America; VIRTUAL, District of Columbia, United States of America; VIRTUAL, Delaware, United States of America; VIRTUAL, Florida, United States of America; VIRTUAL, Georgia, United States of America; VIRTUAL, Idaho, United States of America; VIRTUAL, Illinois, United States of America; VIRTUAL, New Jersey, United States of America; VIRTUAL, New Mexico, United States of America; VIRTUAL, New York, United States of America; VIRTUAL, North Carolina, United States of America; VIRTUAL, North Dakota, United States of America; VIRTUAL, Ohio, United States of America

Date posted 12/06/2022

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Applicant Data Privacy And Protection Notice

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 effectively

Preferred 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 plus

Working Conditions/Physical Requirements:

  • General office demands

Travel:

  • No travel

Unique 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 https://careers.changehealthcare.com

  • *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 https://careers.changehealthcare.com/diversity

Feeling Inspired? Ready to #MakeAChange? Apply today!

#li-remote

New 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 https://careers.changehealthcare.com/diversity

Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

We 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 https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf 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’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Applicant Data Privacy And Protection Notice

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Talent Acquisition Process

Apply

Visit our career site, create a profile, and submit your application. Make sure to observe the job description and see how your background can align to the requirements of the role.

Review

Once you apply for a job opening, the Sourcing Specialist or Talent Advisor will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.

Interview

Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.

Offer

If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.

Onboarding

Once you've electronically signed your offer, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.

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