Clinical Validation Auditor (Cva Auditor)

Company: Change Healthcare Philippines Inc
Website: https://changehealthcare.com
Overview: Change Healthcare is a leading independent healthcare technology and business solutions company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. We help deliver measurable value not only at the point of care, but also before, after, and in between care episodes.

Change Healthcare provides data and analytics-driven solutions and services to help improve clinical, financial, and patient engagement outcomes. We work with payers and providers who want to improve clinical decision-making, simplify billing, collection, payment processes, and enable a better patient experience.

Job Title: CVA Auditor or Clinical Validations Auditor
Location: BGC, Taguig
Salary: Competitive, Dependent on experience
Shift Schedule: Night Shift (9pm-6am)

Job Summary:

The CVA Auditor or Clinical Validations Auditor has an extensive clinical and reimbursement background and is responsible for auditing inpatient medical records and applying clinical criteria and guidelines to ensure documented diagnoses are clinically valid.

The CVA Auditor works closely with DRG analysts and provides clinical insight for DRG validations as necessary as well as performs appeal reviews and responds to provider disputes for Clinical Validation Audits and screens claims data including MS-DRG, AP-DRG, and APR-DRG data.

Qualifications:
· 3 years of clinical nursing experience in the inpatient setting
· 3 years of inpatient coding experience including documented competency in both ICD-9 and ICD-10; or 3 years of inpatient CDI experience; or equivalent
· An active and unrestricted RN license
· Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) preferred
· Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) preferred

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