Medical Review Auditor – Fraud Waste and Abuse

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🇺🇸 United States – Remote

💵 $70k - $91k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 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

• Conducts audit of medical records and healthcare claims assessing the accuracy of medical coding and determining compliance with appropriate policies, procedures, and regulations • Prepares and submits detailed reports on audit findings making recommendations to correct deficiencies and/or practice or process improvements • Conducts medical policy and other relevant research in support of review findings • Uses knowledge of healthcare coding conventions, areas of vulnerability, reimbursement methodologies, and the ability to identify suspicious patterns in medical record documentation • Maintains current knowledge of federal, state, and individual payer policy and coding guidelines • Participates in special projects as required

🎯 Requirements

• Bachelor’s Degree in a related discipline, or the equivalent combination of education, professional training, and work experience • Preferred licenses: Licensed Practical Nurse (LPN), Registered Nurse (RN) • Required Credential: Certified Professional Coder (CPC, CCS, CCS-P) • 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 • Understanding of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state guidelines (including CMS NCCI) • Healthcare claims experience helpful • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program.

🏖️ 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