Associate Auditor, Clinical Validation, DRG

🔥 3 hours ago

🇺🇸 United States – Remote

💵 $31 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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 • Meets or Exceeds Standards/Guidelines for Productivity • Meets or Exceed Standards/Guidelines for Accuracy and Quality • Identifies New Claim Types • Complete all responsibilities as outlined in the annual performance review and/or goal setting

🎯 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: 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 • Proficiency in Word, Access, Excel, TEAMS, and other applications

🏖️ Benefits

• Health insurance • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year