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$143

How much do clinical validation auditor jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for clinical validation auditor in the United States is $38.60, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $32.69 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Clinical Validation Auditor, and why are they important?

To thrive as a Clinical Validation Auditor, you need strong clinical knowledge, expertise in medical coding, and a background in healthcare or nursing, often supported by credentials such as RN, RHIA, or CCS. Familiarity with electronic health record (EHR) systems, coding software, and regulatory guidelines like ICD-10-CM and DRG validation is essential. Excellent analytical skills, attention to detail, and effective communication abilities distinguish top performers in this role. These skills ensure accurate clinical documentation, regulatory compliance, and optimized reimbursement for healthcare organizations.

What is the difference between Clinical Validation Auditor vs Clinical Data Analyst?

AspectClinical Validation AuditorClinical Data Analyst
Required CredentialsCertifications in clinical auditing, healthcare complianceDegrees in health informatics, data analysis, or related fields
Work EnvironmentHealthcare facilities, clinical research settingsHospitals, research institutions, healthcare companies
Employer & Industry UsageUsed in clinical trial oversight, regulatory complianceUsed in data management, reporting, and analysis
Common Search & Comparison IntentUnderstanding auditing roles in clinical validationAnalyzing clinical data for insights

The Clinical Validation Auditor primarily focuses on verifying the accuracy and compliance of clinical data and processes, often working within healthcare or research settings. In contrast, the Clinical Data Analyst interprets clinical data to generate insights and support decision-making. While both roles require familiarity with clinical data, the auditor emphasizes compliance and validation, whereas the analyst emphasizes data analysis and reporting.

What are some common challenges faced by Clinical Validation Auditors when ensuring coding accuracy, and how can these be addressed?

Clinical Validation Auditors often encounter challenges such as incomplete or ambiguous medical documentation, discrepancies between clinical evidence and assigned codes, and keeping up with evolving regulatory guidelines. Addressing these issues typically requires close collaboration with physicians and coding teams, ongoing education, and a detail-oriented approach to reviewing records. Building strong communication skills and staying current with coding standards are essential for effectively navigating these challenges and ensuring accurate, compliant documentation.

What does a Clinical Validation Auditor do?

A Clinical Validation Auditor is responsible for reviewing medical records to ensure that clinical documentation accurately reflects the diagnoses and treatments provided to patients. They verify that the documentation supports the codes assigned for billing and compliance purposes, helping healthcare organizations avoid errors and potential fraud. Clinical Validation Auditors work closely with physicians, coders, and other healthcare professionals to clarify documentation and uphold regulatory standards. Their role is crucial in maintaining the integrity of health records and ensuring appropriate reimbursement.
More about Clinical Validation Auditor jobs
What cities are hiring for Clinical Validation Auditor jobs? Cities with the most Clinical Validation Auditor job openings:
What states have the most Clinical Validation Auditor jobs? States with the most job openings for Clinical Validation Auditor jobs include:
What job categories do people searching Clinical Validation Auditor jobs look for? The top searched job categories for Clinical Validation Auditor jobs are:
Clinical Validation Auditor jobs near you
Infographic showing various Clinical Validation Auditor job openings in the United States as of June 2026, with employment types broken down into 75% Full Time, and 25% Contract. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $80,278 per year, or $38.6 per hour.
Clinical Validation Auditor - Coding and Documentation

Clinical Validation Auditor - Coding and Documentation

Health First

Rockledge, FL • On-site

$30.25 - $40.75/hr

Full-time

Medical, Vision

This job post has expired today. Applications are no longer accepted.

Health First rating

7.4

Company rating: 7.4 out of 10

Based on 113 frontline employees who took The Breakroom Quiz

251st of 872 rated healthcare providers

Job description

Job Requirements
POSITION SUMMARY
To be fully engaged in providing excellence by performing clinical validation and audit reviews, drafting and processing appeals for denials, and reporting trends discovered working collaboratively as a key member of a multidisciplinary team.
PRIMARY ACCOUNTABILITES
  1. Interpret clinical documentation to ensure the health record clearly and consistently supports all diagnoses and procedure codes reported and that it upholds regulatory compliance by consulting and referencing validated coding and documentation references for accurate code assignment and sequencing rules.
  2. Compose appeal letters to governmental and private payers on denials received with clear and effective communication, to include appropriate references, in the validation of the clinical diagnoses as documented in the clinical record. Process appeal letters to payers designated point of contact and ensure timely receipt by payer or auditing agency.
  3. Provides data entry of all data regarding denials and appeals, specifically information which results in unfavorable trends.
  4. Collaborates with Manager, Director, and possibly physician administration communicating physician documentation trends to ensure individual physician communication is delivered in the most agreeable manner.
  5. Perform daily prebill clinical validation audits in coordination with the Inpatient DRG Auditors on accounts that meet specific guidelines for trending OIG, payor specific or CMS target diagnoses. Record findings for monthly compilation and reporting.
  6. Request clarification from provider when there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure or other reportable data element.
  7. Audits and abstracts new technology add on payment (NTAP) diagnoses and procedure codes.
  8. Provides timely notification to medical records/registration personnel of any identified discrepancies of patient information in the medical record.
  9. Work in partnership with representatives from the Patient Financial Service appeals department to ensure accounting and reconciliation of all denials and appeal letters.
  10. Provide ongoing education to physicians, CDI and Coding staff regarding clinical validation audit findings for documentation improvement, physician query opportunities and correct coding, under the supervision of the Auditing Manager and/or the Director of Coding and Clinical Documentation.
  11. Attends monthly department meetings and bi-monthly coding/CDI roundtables.
  12. Maintain and observes patient confidentiality as outlined in the National Patient Safety Goals and HIPAA guidelines that protects the confidentiality of the health record and refuse to access protected health information not required for clinical or coding validation-related services.
  13. Knowledge of structure and content of the electronic health record displaying ability and competency to navigate the EHR accurately and efficiently for reviewing codes/DRG assigned and validation of documented clinical diagnoses.
  14. Other duties and responsibilities as assigned by the Auditing Manager

Work Experience
MINIMUM QUALIFICATIONS
  • Education: Graduate of nursing school (RN or LPN)
  • Work Experience: 2 years nursing and/or clinical documentation experience.
  • Licensure: RN or LPN
  • Certification: Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP)
  • Work Experience in lieu of Certification: 5 years nursing or clinical documentation experience.
  • Skills/Knowledge/Abilities:
  1. Proficient in Microsoft Office - Outlook, Word, Excel, PowerPoint.
  2. Ability to work autonomously with minimal supervision.
  3. Excellent precise written and oral communication skills for professional interaction and presence.
  4. Excellent problem solving, analytical, and critical thinking skills.
  5. Demonstrate the highest standard of customer service skills.
  6. Ability to work well under time pressure meeting deadlines.
  7. Must be detail oriented.
  8. Ability to muti-task.
  9. Must be flexible, accountable, and dependable.

PREFERRED QUALIFICATIONS
  • Work Experience: 3 years clinical documentation experience and 1-year DRG/clinical validation auditing experience.

PHYSICAL REQUIREMENTS
  • Majority of time involves sitting or standing; occasional walking, bending, and stooping.
  • Long periods of computer time or at workstation.
  • Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
  • May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
  • Communicating with others to exchange information.
  • Visual acuity and hand-eye coordination to perform tasks.
  • Workspace may vary from open to confined.
  • May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Schedule : Full-Time
Shift Times : 800am430pm
Paygrade : PG-PG-PG-38

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About Health First

Sourced by ZipRecruiter

Health First has been providing quality care to Brevard county residents for over 23 years. Health First delivers healthcare services throughout Brevard County with a network comprised of 4 hospitals with 868 beds, a health plan, and outpatient/wellness services including diagnostics, home health care, sleep centers, fitness facilities, pharmacy, cardiac rehabilitation, physical therapy, aging services, a hospice program, and bone/wellness center.

Industry

Health care and social assistance and medical equipment and supplies manufacturing

Company size

5,001 - 10,000 Employees

Headquarters location

Rockledge, FL, US

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