DRG Validation Auditor, Clinical & Coding

🕒 July 22

🇺🇸 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 27%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Audit inpatient claims for Coding & Clinical Chart Validation in DRG Validation audits • Integrate medical chart coding principles, clinical guidelines, and objectivity into medical audit activities • Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate audit conclusions • Perform work independently • Use Cotiviti proprietary auditing systems to make audit determinations and generate audit letters • Maintain productivity goals established 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 high-quality, high-value audit concepts, process improvements, and tools • Complete annual performance plan responsibilities • Complete special projects and other assigned duties

🎯 Requirements

• Associate or bachelor’s degree in nursing with an active/unrestricted license, or associate or bachelor’s degree in Health Information Management with RHIA or RHIT, or high school diploma/GED plus equivalent experience • Coding/CDI certification required and maintained: RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS • 5 to 7+ years of experience working with ICD-9/10-CM, MS-DRG, AP-DRG, and APR-DRG • 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, CMS, and other regulatory compliance guidelines and mandates • Expert knowledge of DRG, APR-DRG, ICD-10, CPT, and HCPCS codes • Working knowledge of applicable industry-based standards • Proficiency in Word, Access, Excel, Teams, and other applications • Excellent written and verbal communication skills • Ability to perform duties with or without reasonable accommodation • Ability to provide a dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance • Ability to remain stationary and sit or stand for prolonged periods • Ability to perform repetitive wrist, hand, and/or finger motions

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • 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 • Overtime pay for hours worked in excess of 40 hours per week, or as required by applicable state law • Remote work arrangement • Dedicated secure work area and high-speed internet/office setup support requirements