Senior Auditor, Appeals

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

📋 Description

• Defend Cotiviti’s recovery decisions by applying appropriate guidelines.

• Examine initial claims along with the relevant documentation.

• Make determinations and prepare a written response for each reviewed claim.

• Offer educational insights to the audit and QA teams.

• Uphold a minimum productivity standard as specified for the position.

• Must execute responsibilities with or without reasonable accommodations.

⛳️ Requirements

• Associate's or Bachelor's degree in Nursing (active/unrestricted license required).

• Associate's or Bachelor's degree in Health Information Management (RHIA or RHIT).

• Minimum of 5 years' experience in claims auditing, preferably in a DRG / Clinical Validation Audit environment.

• Coding Certification (RHIA or RHIT, CCS or CIC is preferred).

• Familiarity with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

• 5 to 7+ years of practical knowledge in medical claims billing/payment systems.

• Compliance with official coding guidelines, coding clinic decisions, and CMS regulations.

• Proficient in Word, Access, Excel, and other relevant software applications.

• Strong written and verbal communication abilities.

• Capable of thriving in both individual and team settings.

🏝️ Benefits

• Health insurance.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

• 17-27 days of Paid Time Off (PTO) each year, depending on specific level and duration of service with Cotiviti.