Quality Assurance Auditor – DRG

Job Description

Location: Remote (U.S.-Based)

We are seeking an experienced Senior Quality Assurance Auditor to support clinical validation and claims quality initiatives within a healthcare audit environment. This remote role is responsible for reviewing completed audits to ensure compliance, documentation accuracy, and adherence to established clinical and coding standards.

This position plays a key role in maintaining the integrity of recoverable claims, identifying quality trends, and supporting continuous improvement efforts across audit teams.

The ideal candidate brings strong inpatient audit or clinical validation experience and demonstrates the ability to apply sound judgment, professional skepticism, and regulatory knowledge in a structured review setting.

Responsibilities:

• Conduct quality assurance review of completed clinical and DRG validation audits
• Evaluate medical records to assess medical necessity, level of care, and documentation support
• Collaborate with initial auditors to reconcile differing determinations and support final audit decisions
• Apply healthcare auditing principles with objectivity and consistency
• Identify quality trends and communicate findings to leadership
• Provide mentorship and performance feedback to audit staff
• Support appeals review or initial audit functions based on business needs
• Contribute to process improvement initiatives driven by QA findings

Qualifications:

Education (one required):

• Associate’s or Bachelor’s degree in Nursing with active, unrestricted RN license
• Associate’s or Bachelor’s degree in Health Information Management (RHIA or RHIT)
• Equivalent experience with 5+ years in claims auditing, clinical validation, or recovery audit environments

Certification (one required):

• RHIA or RHIT
• CCS or CIC (Inpatient Coding Credential preferred)
• CPC or CCDS considered with commitment to obtain inpatient coding certification within one year

Experience:

• 3–5 years of healthcare auditing or related experience
• Experience in DRG validation, inpatient coding review, or hospital-based audit environments preferred
• Ability to mentor and support auditor productivity and quality standards
• Strong written and verbal communication skills
• Proficiency in Microsoft Office Suite

Schedule & Work Environment:

• Fully remote position
• Monday through Friday, standard business hours
• Secure, dedicated home workspace required
• Reliable high-speed internet connectivity required
• Prolonged computer-based review and documentation typical

Salary Range:

The salary range for this position is $90,000 – $115,000 annually (approximately $43.27 – $55.29 per hour), based on experience.

Interview Process:

Selected candidates will complete an initial screening with TalentLNX followed by interviews with Clinical Audit Leadership and Quality Assurance Management.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.