Note: The job is a remote job and is open to candidates in USA. Cotiviti is a healthcare auditing company seeking an Associate Auditor for Clinical Validation. This role focuses on Coding & Clinical Chart Validation for inpatient audits, requiring a blend of clinical and coding expertise to ensure accuracy in auditing inpatient claims.
Responsibilities
- Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. This review may include medical record review and/or episode of care reviews. Performs work independently
- Effectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters
- Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team
- Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)
- Identifies New Claim Types. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high quality, high value concept and or process improvement, tools, etc
- Complete all responsibilities as outlined in the annual performance review and/or goal setting
- Complete all special projects and other duties as assigned
- Must be able to perform duties with or without reasonable accommodation
Skills
- Associate or bachelor's degree in nursing (active /unrestricted license)
- Associate or bachelor's degree Health Information Management (RHIA or RHIT)
- Licensed Practical Nurse (LPN) (active /unrestricted license)
- RHIA or RHIT
- CPC or COC
- Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
- Candidates without a current or active coding credential must obtain one within 6 months of hire
- Requires working knowledge of and applicable industry-based standards
- Proficiency in Word, Access, Excel, TEAMS, and other applications
- Excellent written and verbal communication skills
- 2 years of prior clinical and/or coding experience is preferred
- Basic to Intermediate knowledge of medical and coding terminology
- Working knowledge of medical claims billing/payment systems and provider billing guidelines is preferred
Benefits
- Discretionary bonus consideration
- Overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law
- 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, depending on specific level and length of service with Cotiviti
- Must be able to provide a dedicated, secure work area
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance
Company Overview