Clinical Review Auditor

DRG Coder / Clinical Auditor

📍 Remote | Full-Time | 🏥 Healthcare | Clinical Documentation & Coding

About the Role

We’re seeking a detail-oriented DRG Coder / Clinical Auditor to perform DRG validation reviews of medical records and documentation. This role ensures accurate coding and clinical support for DRG assignments, helping improve billing accuracy, reimbursement, and compliance. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally.

Key Responsibilities

• Chart Review & Validation
• Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions.
• Physician Documentation Review
• Confirm that physician notes and clinical indicators support assigned DRGs.
• Audit & Compliance
• Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities.
• Coding Expertise
• Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS).
• Communication & Reporting
• Clearly document findings and communicate results in a professional and concise manner.
• Other Duties
• Support additional documentation and coding-related tasks as assigned.

Qualifications

Licensure : RN or LPN / LVN license required — or RHIT credential for non-nurses.

Experience :

Certifications :

Technical Skills :

Soft Skills :

Tools :

Compensation

💵 Pay Range : $90,000 – $104,841

Salary is based on location, experience, qualifications, and internal equity. Final compensation may vary depending on assessment during the interview process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionals—from staff to leadership—with both clinical and non-clinical employers. Our comprehensive and customer-focused workforce solutions include Direct Placement and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.