Auditor, Clinical Validation – Outpatient Specialty

🕒 Yesterday

🇺🇸 United States – Remote

💵 $95.6k / year

⏰ 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

• Audits Outpatient and Specialty Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims • Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues • Utilizes advanced proficiency, Cotiviti encoder and audit tools required to perform duties • Meets or Exceeds Standards/Guidelines for Productivity • Maintains production goals, accuracy and quality standards set by the audit for the auditing concept • Identifies potential claims outside of the concept where additional recoveries may be available • Develops and implements new ideas, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction

🎯 Requirements

• Associate or bachelor’s degree in nursing (active /unrestricted license) • Coding Certification required and maintained i.e. 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 • A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology • Excellent verbal and written communication skills • Ability to work well in an individual and team environment • Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes

🏖️ 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