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

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 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

• Perform retrospective clinical chart reviews on Readmission and Place of Service claims • Access proprietary systems to audit medical records • Apply nationally accepted guidelines, clinical review judgment, and contract-specific review methodologies • Document audit rationales, findings, and supporting references • Analyze claims and integrate medical chart severity of illness and intensity of service • Use Cotiviti proprietary auditing systems to make audit determinations and generate audit letters • Maintain production goals established by audit operations management • Meet required accuracy and quality standards for claim identification and documentation • Identify potential claims outside the audit concept where additional recoveries may be available • Suggest and develop concept, process-improvement, and tool initiatives • Complete annual Performance Plan responsibilities and assigned special projects

🎯 Requirements

• Associate or Bachelor's degree in nursing • Active, unrestricted RN license in state of residence • 5 to 7+ years of experience working with InterQual/MCG for Inpatient versus Observation reviews • Experience in Utilization Management and/or Case Management • Critical Care background in ICU, Emergency Room, Cath Lab, or Med Surg • Working knowledge of applicable industry-based standards • Proficiency in Word, Access, Excel, TEAMS, and other applications • Excellent written and verbal communication skills • 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 coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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