Auditor Clinical Validation, Place of Service, Short Stay, Readmission

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

📋 Description

• Conducts analysis and audits of claims.

• Incorporates medical chart severity and intensity of service based on clinical guidelines while maintaining objectivity in the execution of medical audit tasks.

• Efficiently employs audit tools.

• Achieves or surpasses productivity standards and guidelines.

• Meets or exceeds accuracy and quality standards and guidelines.

• Recognizes new types of claims.

• Proposes and develops high-quality, valuable concepts and process improvements, tools, etc.

• Fulfill all responsibilities as outlined in the annual Performance Plan.

• Complete all special projects and additional duties as assigned.

⛳️ Requirements

• Associate or Bachelor's degree in nursing.

• Active and unrestricted RN License in the state of residence.

• Case Management Certification is preferred.

• 5 to 7+ years of experience with InterQual/MCG (Inpatient vs Observation).

• Experience in Utilization Management and/or Case Management.

• Background in Critical Care: ICU, Emergency Room, Cath Lab, Med Surg.

• Requires a working knowledge of applicable industry standards.

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

• Strong written and verbal communication abilities.

🏝️ 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, depending on specific level and length of service with Cotiviti.