Remote Healthcare administration Jobs · Clinical Validation

• Oversees a team of Clinical Validation Auditors to ensure productivity and quality standards are met.
• Manages queue distribution, performance optimization, and training for new hires and existing staff.
• Collaborates with Auditors and Quality Assurance to produce high-quality recoverable claims and meet client SLAs.

Cotiviti provides healthcare auditing and analytics solutions to help clients recover overpayments and improve compliance. The company fosters a collaborative and team-oriented culture with a focus on quality and employee development.

• Perform clinical validation and medical record abstraction to ensure accuracy and compliance with CMS quality measures.
• Identify and resolve data discrepancies in collaboration with internal teams and external vendors like Oracle Health.
• Support timely regulatory submissions and cross-train across validation and abstraction functions for workload flexibility.

Banner Health is a large, nonprofit health care system in the US, providing hospital services, primary care, and research across multiple communities. With a network of hospitals and clinics, they employ skilled professionals using advanced technology to improve patient care.

• Analyze and audit inpatient claims for DRG validation, coding accuracy, and clinical appropriateness without a medical record.
• Utilize proprietary auditing systems to make determinations and generate audit letters, meeting productivity and quality standards.
• Identify new claim types and suggest process improvements while maintaining expert ICD-10 and DRG coding knowledge.

Cotiviti is a healthcare analytics and auditing company that helps payers and providers improve financial performance and clinical outcomes. It is a large organization with a culture focused on accuracy, compliance, and collaboration.