Auditor Clinical Validation – Place of Service, Short Stay & Readmission

🔥 19 hours ago

🇺🇸 United States – Remote

💵 $45.7k / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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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 severity of illness and intensity of service based on clinical guidelines and objectivity in performance of medical audit activities • 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. • Complete all responsibilities as outlined on annual Performance Plan • Complete all special projects and other duties as assigned • Must be able to perform duties with or without reasonable accommodation

🎯 Requirements

• Associate or Bachelor's degree in nursing • RN License (active /unrestricted in state of residence) • Case Management Certification (preferred) • 5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation) • Utilization Management and/or Case Management • Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg • 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, depending on specific level and length of service with Cotiviti