California Licensed Clinical Audit SME
Company: VirtualVocations
Location: Waterbury
Posted on: April 13, 2025
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Job Description:
A company is looking for a Senior Clinical Audit Subject Matter
Expert.
Key Responsibilities
Conduct comprehensive Clinical DRG validation audits and reviews
for compliance with payer policies and regulations
Serve as a clinical expert for product development and assist in
developing clinical policies
Perform quality assessments and identify training opportunities
based on audit outcomes
Required Qualifications, Training, and Education
Associates or Bachelor's degree in Nursing
10+ years of experience in claims auditing, quality assurance, or
recovery auditing
Certifications: RHIA or RHIT, CDIP or CCDS (required), CCS or CIC
(preferred), RN with current licensure (required)
5-10 years of nursing experience in a facility setting
Experience with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG in a payer or
vendor setting
Keywords: VirtualVocations, Parsippany-Troy Hills Township , California Licensed Clinical Audit SME, Accounting, Auditing , Waterbury, New Jersey
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