DRG Validation Auditor - Off Hours Work (2nd, 3rd, or weekend shift work)

Cotiviti • Remote,

14d • Remote

About The Position

The DRG Validation Auditor works on Cross Claim Clinical Reviews (CCCR), performing DRG validation for prepay and retrospective audits and making determinations without a medical record. The role audits inpatient claims and documents audit results, focusing on clinical review, coding accuracy, and the appropriateness of treatment setting, services delivered, and patient history. The position requires a strong inpatient health information management and coding background, together with an understanding of clinical validation, and involves working independently.

This is a full-time, hourly, nonexempt position scheduled for an off-hours shift: either 3 PM–11 PM or 11 PM–7 AM ET, including weekends and holidays. The role is remote and requires a dedicated, secure work area, high-speed internet, and an office setup. Compensation is $45.67 per hour (approximately $95,000 annualized), with eligibility for discretionary bonus consideration and overtime pay under the stated conditions. The posting date is 10/27/2026; the anticipated application window close date is 12/27/2026, subject to change.

Requirements

• At least one of the following education or experience pathways: an associate or bachelor’s degree in nursing with an active, unrestricted license; an associate or bachelor’s degree in Health Information Management with RHIA or RHIT; or a high school diploma or GED plus equivalent experience of 5+ years in claims auditing, quality assurance, or recovery auditing.
• Maintain at least one of the following coding/CDI credentials as a condition of employment: RHIA or RHIT; CPC; or an inpatient coding credential such as CCS, CIC, CDIP, or CCDS.
• 5 to 7+ years of experience working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, with broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• Adherence to official coding guidelines, Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
• Expert coding knowledge of DRG, APR-DRG, ICD-10, CPT, and HCPCS codes.
• Working knowledge of applicable industry-based standards.
• Proficiency in Word, Access, Excel, TEAMS, and other applications.
• Excellent written and verbal communication skills.
• Ability to communicate with others to exchange information and assess the accuracy, neatness, and thoroughness of assigned work.
• Ability to remain in a stationary position, often standing or sitting for prolonged periods, and perform repetitive motions involving the wrists, hands, and/or fingers.
• Ability to provide a dedicated, secure work area, high-speed internet access/connectivity, and office setup and maintenance.

Responsibilities

• Analyze and audit claims, applying medical chart coding principles, clinical guidelines, and objectivity to medical audit activities.
• Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to support audit conclusions; perform work independently.
• Use Cotiviti proprietary auditing systems to make audit determinations and generate audit letters.
• Meet productivity goals established by audit operations management.
• Meet audit standards for accuracy and quality in claim validation, identification, and documentation, including letter writing.
• Identify potential claims outside the assigned concept where additional recoveries may be available.
• Suggest and develop high-quality, high-value concepts, processes, and tools for improvement.
• Complete responsibilities outlined in the annual Performance Plan.
• Complete special projects and other duties as assigned.
• Perform duties with or without reasonable accommodation.

Benefits

• Medical, dental, and vision insurance coverage.
• Disability and life insurance coverage.
• 401(k) savings plan.
• Paid family leave.
• 9 paid holidays per year.
• 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service.
• Eligibility for discretionary bonus consideration.
• Overtime pay for nonexempt employees for hours worked in excess of 40 in a week, or as required by applicable state law.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree