Auditor Clinical Validation DRG

Responsibilities

• Analyzes and Audits Claims
• Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.
• Performs work independently.
• Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
• Maintains production goals set by the audit operations management team.
• Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing).
• Identifies New Claim Types
• Suggests and develops high quality, high value concept and or process improvement, tools, etc.

Qualifications

• Education: Associate or bachelor’s degree in nursing (active /unrestricted license), Associate or bachelor’s degree Health Information Management (RHIA or RHIT), High school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing.
• Coding/CDI Certification: RHIA or RHIT, CPC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS.
• Experience: 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.

Benefits

• Base compensation is paid hourly at $45.67 per hour (95k annualized).
• Eligible for discretionary bonus consideration.
• Competitive benefits package including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year.