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Clinical Validation Auditor Jobs (NOW HIRING)

Cotiviti

Auditor Clinical Validation DRG

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding ...

Cotiviti

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding ...

Cotiviti

DRG Validation Auditor (Clinical & Coding)

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). The ideal candidate for this position needs to have both a clinical (nurse) and ...

Parallon

DRG Validation Auditor

Nashville, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to ... and clinical/medical resources to assure coding knowledge and skills remain current What ...

Cotiviti

$45.67/hr

Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). The ideal candidate for this position needs to have both a clinical (nurse) and ...

Parallon

DRG Validation Auditor

Murfreesboro, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to ... and clinical/medical resources to assure coding knowledge and skills remain current What ...

Parallon

DRG Validation Auditor

Franklin, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to ... and clinical/medical resources to assure coding knowledge and skills remain current What ...

Parallon

DRG Validation Auditor

Lebanon, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to ... and clinical/medical resources to assure coding knowledge and skills remain current What ...

MMC Group

DRG Auditor

San Antonio, TX · Remote

A leader in providing clinical auditing services to public and commercial healthcare payers throughout the US, has openings for remote DRG Validation Auditors. As members of the DRG Validation Team ...

CGI Inc.

Clinical Nurse Auditor

Atlanta, GA · On-site

... validate clinical services, and prepare detailed audit determinations. You will receive ... Medical Auditor (CPMA), Certified Professional Coder (CPC), or other relevant healthcare ...

MedReview

DRG Clinical Validation Nurse

New York, NY · Remote

$85K - $95K/yr

We are seeking a registered nurse with experience in clinical validation to work within our coding ... May consider nurses with inpatient claims auditing experience or case management experience.

MedReview

DRG Clinical Validation Nurse

Manhattan, NY · On-site +1

$85K - $95K/yr

We are seeking a registered nurse with experience in clinical validation to work within our coding ... May consider nurses with inpatient claims auditing experience or case management experience.

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Clinical Validation Auditor information

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$12

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How much do clinical validation auditor jobs pay per hour?

As of Aug 10, 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?

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 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.
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Clinical Validation Auditor jobs near you
Infographic showing various Clinical Validation Auditor job openings in the United States as of August 2026, with employment types broken down into 86% Full Time, 9% Part Time, and 5% Contract. Highlights an 64% In-person, and 36% Remote job distribution, with an average salary of $80,278 per year, or $38.6 per hour.

DRG/Clinical Validation Auditor RN

UnitedHealth Group

Plymouth, MN • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

186th of 887 rated healthcare providers

Job description

$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS
Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.
In this position as a Clinical DRG RN auditor, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification
  • Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
  • Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
  • Perform clinical coding review to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing
  • Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
  • Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics
  • Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly
  • Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
  • Maintain and manage daily case review assignments, with a high emphasis on quality
  • Provide clinical support and expertise to the other investigative and analytical areas
  • Work in a high-volume production environment that is matrix driven

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Associate's degree
  • Unrestricted RN (Registered Nurse) license
  • CCS/CIC or willing to obtain certification within 6 months of hire
  • 2+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
  • 2+ years of ICD-10-CM coding experience including but not limited to expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
  • 2+ years of ICD-10-PCS coding experience including but not limited to expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers

Preferred Qualifications:
  • Experience with prior DRG concurrent and/or retrospective overpayment identification audits
  • Experience working with Utilization Management
  • Experience with readmission reviews of claims
  • Experience with DRG encoder tools (ex. 3M)
  • Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
  • Healthcare claims experience
  • Managed care experience
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines

Soft Skills:
  • Ability to use a Windows PC with the ability to utilize multiple applications at the same time
  • Ability to work independently in a remote environment and deliver exceptional results
  • Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail
  • Excellent time management and work prioritization skills

Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Have a secluded office area in which to perform job duties during the work day
  • Have reliable high-speed internet access and a work environment free from distractions

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
PLEASE NOTE The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $35.00 to $62.50 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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