Associate Auditor, Clinical Validation, DRG

🕒 April 28

🇺🇸 United States – Remote

💵 $31 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Analyzes and Audits Claims • Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities • Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions • Performs work independently • Effectively Utilizes Audit Tools • Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters • Meets or Exceeds Standards/Guidelines for Productivity • Maintains production goals set by the audit operations management team • Meets or Exceed Standards/Guidelines for Accuracy and Quality • Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing) • Identifies New Claim Types • Identifies potential claims outside of the concept where additional recoveries may be available • Suggests and develops high quality, high value concept and or process improvement, tools, etc.

🎯 Requirements

• Associate or bachelor’s degree in nursing (active /unrestricted license) • Associate or bachelor’s degree Health Information Management (RHIA or RHIT) • Licensed Practical Nurse (LPN) (active /unrestricted license) • Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): RHIA or RHIT, CPC or COC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS • 2 years of prior clinical and/or coding experience is preferred • Basic to Intermediate knowledge of medical and coding terminology • Working knowledge of medical claims billing/payment systems and provider billing guidelines is preferred • Requires working knowledge of and applicable industry-based standards • Proficiency in Word, Access, Excel, TEAMS, and other applications • Excellent written and verbal communication skills.

🏖️ Benefits

• medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year