Cotiviti - US
Auditor Clinical Validation DRG
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Job Description
- Req#: 17279
Employer Industry: Healthcare Auditing
Why consider this job opportunity:
- Salary up to $45.67 per hour (approximately $95,000 annually)
- Eligible for discretionary bonus consideration
- Comprehensive benefits package including medical, dental, vision, disability, and life insurance
- Generous Paid Time Off (PTO) ranging from 17-27 days per year based on service length
- Opportunity for career advancement and professional growth within the organization
- Flexible work environment with remote work options available
What to Expect (Job Responsibilities):
- Analyze and audit medical claims, integrating coding principles and clinical guidelines
- Utilize proprietary auditing systems to make determinations and generate audit letters
- Maintain productivity and accuracy standards set by the audit operations management team
- Identify potential claims for additional recoveries and suggest process improvements
- Complete all responsibilities as outlined in the annual Performance Plan and special projects as assigned
What is Required (Qualifications):
- Associate or bachelor’s degree in nursing (active/unrestricted license) or Health Information Management (RHIA or RHIT)
- High school diploma or GED with 5+ years of experience in claims auditing or recovery auditing
- Coding/CDI Certification (RHIA, RHIT, CPC, CCS, CIC, CDIP, or CCDS required)
- 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG, with knowledge of medical billing and coding
- Proficiency in Word, Access, Excel, TEAMS, and strong written and verbal communication skills
How to Stand Out (Preferred Qualifications):
- Experience in DRG/Clinical Validation Audit settings or hospital environments
- Advanced knowledge of coding guidelines, compliance regulations, and payer reimbursement policies
- Strong attention to detail and ability to assess the accuracy and thoroughness of work
#HealthcareAuditing #RemoteWork #CareerOpportunity #CompetitivePay #BenefitsPackageAbout the company
Cotiviti is a solutions and analytics company leveraging unparalleled clinical and financial datasets to deliver insight into the healthcare system’s performance.
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