Senior Auditor, Appeals

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $101k / year

⏰ Full Time

🟠 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

• Defend Cotiviti’s recovery determinations utilizing appropriate guidelines • Review initial claim along with associated documentation • Render a decision and formulate a written response on each claim reviewed • Provide educational feedback to the audit and QA team • Maintain a minimum productivity standard as outlined for the role • Must perform duties with or without reasonable accommodation.

🎯 Requirements

• Associates or Bachelor's degree in Nursing (active/unrestricted license) • Associate or Bachelor's degree in Health Information Management (RHIA or RHIT) • Equivalent experience of 5+ years experience in claims auditing, ideally in a DRG / Clinical Validation Audit setting • Coding Certification (RHIA or RHIT, CCS or CIC preferred) • Experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG • 5 to 7+ years of working knowledge of medical claims billing/payment systems • Adherence to official coding guidelines, coding clinic determinations, and CMS regulations • Proficiency in Word, Access, Excel, and other applications. • Excellent written and verbal communication skills. • Ability to work well in an individual and team environment.

🏖️ Benefits

• Health insurance • 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.