Outpatient Clinical Audit & Coding Specialist

Cotiviti; Idaho; On-site; USD 80,750 - 109,250; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) savings plan

Paid holidays

Paid time off (PTO)

Job summary

Cotiviti in Idaho is seeking an auditing professional focused on Coding & Clinical Chart Validation for Outpatient and Specialty audits. The ideal candidate combines a nursing background with coding/auditing expertise across SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service.

The role audits outpatient/specialty claims, documents results, emphasizes medical necessity and appropriate setting, and uses Cotiviti tools.

Qualifications

• Active nursing degree with licensing and coding certification.
• 5 to 7 years in clinical medical record coding or auditing.
• Excellent communication, HIPAA and CMS security knowledge.
• Expert DRG/ICD-10/CPT/HCPCS coding understanding and guidelines.

Responsibilities

• Audit outpatient and specialty claims with focus on coding accuracy and medical necessity.
• Review medical records and apply coding principles to identify issues.
• Utilize Cotiviti tools and enter claims accurately into the system.
• Identify new claim types and propose process improvements.
• Deliver high quality audits and meet productivity standards.

Skills

Nursing background

Coding knowledge

HIPAA knowledge

Education

Associate or Bachelor’s degree in nursing (active /unrestricted license)

Nursing license active

Coding Certifications (CPC, CIC, CCS, CCS-P, RHIA or RHIT)

Tools

Cotiviti encoder

Job description

Cotiviti in Idaho is seeking an auditing professional focused on Coding & Clinical Chart Validation for Outpatient and Specialty audits. The ideal candidate combines a nursing background with coding/auditing expertise across SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service.

The role audits outpatient/specialty claims, documents results, emphasizes medical necessity and appropriate setting, and uses Cotiviti tools.