Associate Auditor, Clinical Validation, DRG

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyzes and audits claims.

• Incorporates medical chart coding principles, clinical guidelines, and objectivity in the execution of medical audit tasks.

• Leverages advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to support conclusions.

• Conducts work independently.

• Effectively utilizes auditing tools.

• Employs Cotiviti proprietary auditing systems with a high degree of proficiency to make audit decisions and produce audit letters.

• Meets or exceeds productivity standards and guidelines.

• Adheres to production goals established by the audit operations management team.

• Meets or surpasses accuracy and quality standards and guidelines.

• Achieves the expected level of accuracy and quality set by the audit for valid claim identification and documentation (letter writing).

• Identifies new claim types.

• Recognizes potential claims outside of the concept where additional recoveries may be possible.

• Proposes and develops high-quality, high-value concepts and/or process improvements, tools, etc.

⛳️ Requirements

• Associate or bachelor’s degree in nursing (active/unrestricted license).

• Associate or bachelor’s degree in Health Information Management (RHIA or RHIT).

• Licensed Practical Nurse (LPN) (active/unrestricted license).

• Coding/CDI Certification (at least one of the following is required and must be maintained as a condition of employment): RHIA or RHIT, CPC or COC, Inpatient Coding Credential – CCS, CIC, CDIP, or CCDS.

• A minimum of 2 years of 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.

• Requires a working knowledge of and adherence to applicable industry-based standards.

• Proficiency in Word, Access, Excel, TEAMS, and other applications.

• Exceptional written and verbal communication skills.

🏝️ Benefits

• 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.