Medical Review Auditor – Fraud Waste and Abuse

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $70k - $91k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 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

• Audit medical records and healthcare claims to assess medical coding accuracy and compliance with policies, procedures, and regulations • Prepare and submit detailed reports on audit findings • Make recommendations to correct deficiencies and improve practices or processes • Conduct medical policy and relevant research to support review findings • Apply knowledge of healthcare coding conventions, vulnerabilities, reimbursement methodologies, and suspicious documentation patterns • Maintain current knowledge of federal, state, and individual payer policy and coding guidelines • Participate in special projects as required

🎯 Requirements

• Bachelor’s Degree in a related discipline, or equivalent combination of education, professional training, and work experience • Required credential: Certified Professional Coder (CPC, CCS, CCS-P) • Preferred licenses: Licensed Practical Nurse (LPN) and Registered Nurse (RN) • 2-5 years of related experience in auditing medical records • Computer proficiency in MS Office suite • Excellent verbal and written communication skills • Strong listening and observation skills • Attention to detail and a high level of accuracy • Effective organizational and prioritization skills with multi-tasking ability • Ability to conduct research in support of medical review determinations • Understanding of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state guidelines, including CMS NCCI • Healthcare claims experience helpful • Ability to work independently and collaborate well with peers and customers • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program • Ability to positively handle/manage stress, including high work volume and frequent change • Must be able to provide a dedicated, secure work area • Access to high-speed internet is required

🏖️ Benefits

• Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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 level and length of service • Work-at-home arrangement • Dedicated, secure work area • High-speed internet access required; all other equipment will be provided