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

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 • Utilize nationally accepted guidelines, clinical review judgment and contract-specific review methodologies • Access proprietary systems to audit medical records • Apply critical thinking and decision-making skills to make audit determinations • Accurately document rationales, findings and supporting references • Analyze and audit claims by integrating medical chart severity of illness and intensity of service • Utilize Cotiviti proprietary auditing systems and generate audit letters • Maintain productivity goals set by audit operations management • Meet accuracy and quality standards for valid 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 opportunities • Complete annual Performance Plan responsibilities, special projects and assigned duties

🎯 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 (Inpatient vs Observation) • Experience in Utilization Management and/or Case Management • Critical Care background: ICU, Emergency Room, Cath Lab, 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 • Overtime pay for hours worked in excess of 40 hours per week, or as required by applicable state law • 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