Clinical Auditor, Outpatient Specialty

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $45.6k / 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 Outpatient and Specialty Claims • Utilizes medical chart coding principles and client specific guidelines • Performs work independently, reviews and interprets medical records • Utilizes advanced proficiency, Cotiviti encoder and audit tools • Maintains production goals, accuracy and quality standards • Identifies potential claims outside of concept for additional recoveries • Suggests, develops and implements new ideas for audit production 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 • Broad knowledge of medical claims billing/payment systems provider billing guidelines • Adherence to official coding guidelines and coding clinic determinations • Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes • Excellent verbal and written communication skills • Ability to work well in an individual and team environment

🏖️ Benefits

• Medical, dental, vision insurance • 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