Auditor, Clinical Validation, OPSP Coding

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

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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

• Audit outpatient and specialty claims • Apply medical chart coding principles and client-specific guidelines to outpatient, pharmacy, and/or inpatient DRG claims • Use advanced coding expertise and industry knowledge to substantiate audit conclusions • Independently review and interpret medical records to identify billing and coding issues • Use Cotiviti encoder and audit tools • Enter claims accurately into the Cotiviti system according to standard procedures • Meet productivity, accuracy, quality, and production standards • Identify potential claims outside the assigned audit concept where additional recoveries may be available • Suggest and develop high-quality, high-value audit concepts, process improvements, and tools • Apply knowledge of client requirements, contract terms, and complex claim types • Suggest, develop, and implement ideas, approaches, and technological improvements to enhance audit production, communication, and client satisfaction • Evaluate information and draw logical conclusions • Complete responsibilities in the annual Performance Plan • Complete special projects and other assigned duties

🎯 Requirements

• Associate or bachelor’s degree in Health Information Management (RHIA or RHIT), or equivalent combination of relative work experience • Coding certification required and maintained, such as CPC, CIC, CCS, CCS-P, RHIA, or RHIT • 5 to 7 years of experience with clinical medical record coding or auditing • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology • Ability to become proficient in various outpatient and specialty review types • Adherence to official coding guidelines, Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates • Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes • Excellent verbal and written communication skills • Ability to work independently and in a team environment • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance • Ability to perform duties with or without reasonable accommodation

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • 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 • Overtime pay for nonexempt employees for hours worked in excess of 40 hours in a week, or as required by applicable state law • Remote work arrangement • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the employee