LogoFresh Jobs Ahead
Cotiviti
Cotiviti
5,001 – 10,000 Employees
H1B Visa SponsorConsultingHealthcareLogistics
Cotiviti is a healthcare technology and analytics company that helps health plans, government agencies, and healthcare providers improve payment accuracy, operational performance, and care quality. Its data-driven solutions support risk adjustment, payment policy management, and member engagement, turning complex healthcare information into insights that can strengthen both financial and clinical outcomes across the healthcare ecosystem.
LinkedIn
Company Jobs

Clinical Validation Coding Auditor (Remote)

Audit outpatient and specialty healthcare claims for Cotiviti, validating clinical documentation, coding accuracy, medical necessity, and billing issues. Apply advanced coding expertise to support accurate audit conclusions and potential claim recoveries.

USUnited States
$45 / hour
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Description

  • Audit outpatient and specialty claims
  • Apply medical chart coding principles and client-specific guidelines to outpatient, pharmacy, and/or inpatient DRG claims
  • Use advanced coding expertise and industry knowledge to support audit conclusions
  • Independently review and interpret medical records to identify billing and coding issues
  • Operate Cotiviti encoder and audit tools
  • Enter claims accurately into Cotiviti systems using standard procedures
  • Meet productivity, accuracy, quality, and production expectations
  • Identify claims outside the assigned audit concept that may offer additional recovery opportunities
  • Recommend and develop valuable audit concepts, process improvements, and tools
  • Apply knowledge of client requirements, contract terms, and complex claim types
  • Develop and implement process, communication, and technology improvements that enhance audit production and client satisfaction
  • Evaluate information and reach logical conclusions
  • Fulfill responsibilities outlined in the annual Performance Plan
  • Complete special projects and other assigned duties

Requirements

  • Associate or bachelor’s degree in Health Information Management, RHIA or RHIT credential, or an equivalent combination of relevant work experience
  • Maintain a required coding certification such as CPC, CIC, CCS, CCS-P, RHIA, or RHIT
  • Bring 5 to 7 years of clinical medical record coding or auditing experience
  • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
  • Broad understanding of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
  • Ability to become proficient in multiple outpatient and specialty review types
  • Follow official coding guidelines, Coding Clinic determinations, and CMS and other regulatory compliance requirements
  • Expertise with DRG, ICD-10, CPT, and HCPCS codes
  • Strong verbal and written communication skills
  • Ability to work independently and collaboratively
  • Ability to maintain a dedicated, secure work area
  • Ability to provide high-speed internet connectivity and maintain the required office setup
  • Ability to perform the role with or without reasonable accommodation

Benefits

  • Eligibility for discretionary bonus consideration
  • Medical insurance
  • Dental insurance
  • Vision insurance
  • Disability insurance
  • Life insurance coverage
  • 401(k) savings plan
  • Paid family leave
  • Nine paid holidays annually
  • 17–27 days of paid time off per year, based on level and length of service
  • Overtime pay for nonexempt employees working more than 40 hours per week or as required by applicable state law
  • Remote work arrangement
  • Employee-provided dedicated secure workspace, high-speed internet connectivity, and office setup and maintenance

Related Jobs