Cotiviti · United States · Just now · 0 applicants
NewRemoteFull-timeSenior
Pay
$45/hrListed
Workplace
Remote
Job type
Full-time
Level
Senior
Source: jobright · Posted by joined-scrapper
About the role
Audits outpatient and specialty claims for coding accuracy and medical necessity, leveraging clinical and coding expertise to document findings and ensure compliance.
What you’ll do
Review clinical records for coding accuracy and medical necessity
Evaluate appropriateness of treatment settings and services
Document audit results
Work independently to interpret medical records
Apply advanced coding principles to identify billing issues
Use Cotiviti encoder and audit tools
What you’ll need
Active/unrestricted nursing license
Coding certification (CPC, CIC, CCS, CCS-P, RHIA, or RHIT)
5-7 years of clinical medical record coding or auditing experience
Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
Knowledge of medical claims billing/payment systems and payer policies
Expert coding knowledge in DRG, ICD-10, CPT, and HCPCS
Original job description
Cotiviti is hiring an Auditor Clinical Validation Outpatient Specialty Clinical to audit outpatient and specialty claims. The role reviews clinical records for coding accuracy, medical necessity, and appropriateness of treatment settings and services, and documents audit results.The ideal candidate for this position needs to have both a clinical (nurse)…