Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on healthcare analytics and auditing services. They are seeking a DRG Validation Auditor with a clinical and coding background to perform auditing of inpatient claims, ensuring coding accuracy and appropriateness of treatment settings.
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. 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 on annual Performance Plan
- Complete all special projects and other duties as assigned
- Must be able to perform duties with or without reasonable accommodation
- Complete all responsibilities as outlined on annual Performance Plan
- 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)
- High school diploma or GED plus equivalent experience of 5+ years' experience in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment
- RHIA or RHIT
- CPC
- Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
- 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a 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 and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes
- Requires working knowledge of and applicable industry-based standards
- Proficiency in Word, Access, Excel, TEAMS, and other applications
- Excellent written and verbal communication skills
- Communicating with others to exchange information
- Assessing the accuracy, neatness, and thoroughness of the work assigned
- Remaining in a stationary position, often standing or sitting for prolonged periods
- Repeating motions that may include the wrists, hands, and/or fingers
- 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
- No adverse environmental conditions expected
Benefits
- This role is eligible for discretionary bonus consideration.
- Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including 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
- Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law
Company Overview
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