Remote Senior QA Auditor – Healthcare Claims

Cotiviti; Oregon; Hybrid; USD 65,000 - 77,000; Full time

Job summary

Cotiviti is seeking a Sr. Auditor, Quality Assurance to lead clinical quality reviews of daily audit work, determine medical necessity, and ensure adherence to established procedures.

The role emphasizes objective judgment, documentation accuracy, and process improvement opportunities across outpatient reviews and other care settings. Ideal candidates have RN degree, 5+ years in claims auditing, and relevant coding credentials.

Qualifications

• Associates or Bachelor's degree in Nursing (active/unrestricted license).
• 5+ years experience in claims auditing, quality assurance, or recovery auditing.
• Mentor staff and enhance performance.
• Excellent verbal and written communication skills.
• Ability to work well in an individual and team environment.

Responsibilities

• Performs clinical quality assurance review of daily validation reviews.
• Communicates with the initial auditor when there are differing decisions.
• Applies in-depth knowledge of clinical criteria to determine medical necessity.
• May mentor QA auditors or initial auditors.
• May flex into the initial audit or appeals role as needed.

Skills

Verbal communication

Mentoring

Team collaboration

Office software

Education

Nursing degree

RHIA/RHIT

CCS or CIC

CCDS or CPC

Tools

Microsoft Office

SharePoint

Excel

Job description

Cotiviti is seeking a Sr. Auditor, Quality Assurance to lead clinical quality reviews of daily audit work, determine medical necessity, and ensure adherence to established procedures.

The role emphasizes objective judgment, documentation accuracy, and process improvement opportunities across outpatient reviews and other care settings. Ideal candidates have RN degree, 5+ years in claims auditing, and relevant coding credentials.