Remote Clinical Validation Auditor – Outpatient Coding

Cotiviti; United States; Remote; USD 52,000 - 74,000; Full time

Benefits offered by this job

Medical, dental, vision, disability, &

Life insurance and 401(k) savings

Job summary

Cotiviti is seeking an Auditor for Clinical Validation in outpatient and specialty audits, focusing on clinical review, coding accuracy, medical necessity, and appropriate care setting. A nursing background and coding/auditing credentials are required, with the ability to work remotely within the United States.

The role involves auditing outpatient/specialty claims, applying client guidelines, and using Cotiviti encoder and audit tools to ensure quality, productivity, and compliance.

Qualifications

• Associate or bachelor’s degree in nursing with active license.
• Coding certification required (CPC, CIC, CCS, CCS-P, RHIA or RHIT).
• 5 to 7 years of experience with clinical medical record coding or auditing.
• Knowledge of HIPAA privacy and CMS rules.
• Excellent verbal and written communication skills.
• Ability to work independently and in a team.

Responsibilities

• Audits Outpatient and Specialty Claims.
• Uses coding principles and client guidelines in audits.
• Draws on advanced coding expertise to substantiate conclusions.
• Reviews medical records and applies coding knowledge to identify issues.
• Identifies new claim types and potential recoveries.
• Suggests and develops process improvements and tools.
• Completes responsibilities per performance plan and special projects.

Skills

Nursing background

Coding knowledge

Auditing experience

HIPAA knowledge

Communication skills

Education

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

Coding certification (CPC/CIC/CCS/CCS-P/RHIA/RHIT)

Experience with clinical medical record coding or auditing

HIPAA knowledge (privacy & CMS rules)

Knowledge of medical claims billing & payer policies

Tools

Cotiviti encoder

Job description

Cotiviti is seeking an Auditor for Clinical Validation in outpatient and specialty audits, focusing on clinical review, coding accuracy, medical necessity, and appropriate care setting. A nursing background and coding/auditing credentials are required, with the ability to work remotely within the United States.

The role involves auditing outpatient/specialty claims, applying client guidelines, and using Cotiviti encoder and audit tools to ensure quality, productivity, and compliance.