Auditor, DRG Validation – CMS Audits

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🇺🇸 United States – Remote

💵 $45.7k / hour

⏰ 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 Inpatient DRG Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with 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 • Effectively Utilizes Audit Tools: Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters • Meets or Exceeds Standards/Guidelines for Productivity: Maintains production goals set by the audit operations management team • Meets or Exceeds Standards/Guidelines for Accuracy and Quality: Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)

🎯 Requirements

• Associate or bachelor’s degree Health Information Management (RHIA or RHIT) • High school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing • Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): RHIA or RHIT, CPC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology • Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates • Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes • Requires working knowledge of and applicable industry-based standards • Proficiency in Word, Access, Excel, TEAMS, and other applications • Excellent written and verbal communication skills

🏖️ 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