Performs clinical quality assurance review of daily clinical validation reviews and communicates with initial auditors on differing decisions.
Integrates healthcare auditing principles and uses objectivity in medical audit activities and review.
May review medical records and apply clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns.

Qualifications:

Associates or Bachelor's degree in Nursing with active/unrestricted license, or equivalent experience in claims auditing, quality assurance, or recovery auditing.
Coding Certification such as RHIA, RHIT, CCS, CIC, CCDS, or CPC required.
3-5 years of healthcare auditing or related experience, with ability to mentor staff and enhance performance.

Benefits:

Competitive medical, dental, vision, disability, and life insurance coverage.
401(k) savings plans and paid family leave.
9 paid holidays per year and 17-27 days of Paid Time Off (PTO) per year, depending on level and length of service.

Cotiviti

Cotiviti provides healthcare auditing and recovery solutions to ensure high quality recoverable claims. As a company, it employs a sizable workforce and fosters a culture of compliance, accuracy, and continuous improvement through professional skepticism and mentorship.

Apply for This Position