Clinical Review Auditor I
CERISFort Worth, Texas, United States
Posted March 23, 2026
63739 - 95264 USD
Full Time
About the Company
CERIS, a CorVel company, specializes in payment integrity solutions for healthcare payers, ensuring medical claims are processed accurately the first time. The firm offers a comprehensive suite of services—including itemization review, clinical review, implant cost analysis, and predictive claim selection—to detect and resolve pre‑ and post‑payment issues. Leveraging data mining, fraud detection, and provider contract compliance expertise, CERIS delivers significant cost savings by preventing improper payments and recovering overpayments. Its collaborative relationships with the medical community and proven track record make it a trusted partner for state agencies, commercial payors, managed care organizations, and third‑party administrators nationwide.
Job Description
The Clinical Review Auditor I will perform DRG validation reviews of medical records and/or other documentation, determining correct DRG/coding as defined by review methodologies. This role involves medical record reviews, accurate documentation, and clinical/policy/regulatory support.
Requirements
- Valid LVN or RN license in the state of employment
- CCS or CIC certification with DRG auditing experience in ICD-10-CM, ICD-10 PCS
- Experience in the OR, ICU, or ER as an RN is highly preferred
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid time off
