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Cotiviti
Cotiviti
5.001 – 10.000 Angajați
Sponsor pentru viza H1BAsistență medicalăConsultanțăLogistică
Cotiviti este o companie de tehnologie și analiză a datelor din domeniul sănătății, care ajută planurile de sănătate, agențiile guvernamentale și furnizorii de servicii medicale să îmbunătățească acuratețea plăților, performanța operațională și calitatea îngrijirii. Soluțiile sale bazate pe date sprijină ajustarea în funcție de risc, gestionarea politicilor de plată și implicarea membrilor, transformând informațiile medicale complexe în perspective care pot consolida atât rezultatele financiare, cât și pe cele clinice în întregul ecosistem de sănătate.
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Clinical Validation Auditor – Outpatient Specialty (Remote)

Validate outpatient and specialty claims for Cotiviti’s healthcare payment integrity services. Review clinical records, coding accuracy, medical necessity, and services delivered.

USStatele Unite ale Americii
45 $ / oră
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • Audit outpatient and specialty claims, including APC, PNPP, pharmacy, and/or inpatient DRG claims
  • Conduct coding and clinical chart validation for outpatient and specialty audits
  • Examine medical records to identify billing and coding discrepancies
  • Evaluate clinical review findings, coding accuracy, medical necessity, treatment settings, and delivered services
  • Apply medical chart coding standards and client-specific guidelines
  • Use Cotiviti Encoder and related audit tools
  • Enter claims accurately into Cotiviti’s system
  • Meet productivity, accuracy, quality, and valid claim identification and documentation standards
  • Flag potential claims outside the assigned audit concept when additional recovery opportunities may exist
  • Recommend and develop audit concepts, process improvements, tools, and technology enhancements
  • Apply ideas and methods that support audit production, communication, and client satisfaction
  • Analyze information and reach sound conclusions
  • Complete annual Performance Plan responsibilities, special projects, and other assigned duties

Cerințe

  • Associate or bachelor’s degree in nursing
  • Active, unrestricted nursing license
  • Maintain a required coding certification such as CPC, CIC, CCS, CCS-P, RHIA, or RHIT
  • Five to seven years of experience in clinical medical record coding or auditing
  • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
  • Broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
  • Ability to learn and become proficient in 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

Beneficii

  • Eligibility for discretionary bonus consideration
  • Medical insurance
  • Dental insurance
  • Vision insurance
  • Disability insurance
  • Life insurance
  • 401(k) savings plan
  • Paid family leave
  • Nine paid holidays per year
  • 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 state law
  • Remote work arrangement
  • Team-member-provided dedicated, secure work area and high-speed internet and office setup

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