Remote Senior QA Auditor - Healthcare Claims

Cotiviti

United States

Remote

USD 65,000 - 77,000

Full time

6 days ago

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Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) savings plan

Paid holidays

Paid time off

Discretionary bonus

Job summary

Cotiviti is seeking a Senior Auditor, Quality Assurance to ensure clinical validation reviews meet quality standards across outpatient and specialty claims. This role emphasizes adherence to procedures, accuracy, and opportunities for process improvements, with potential to mentor other QA staff.

The ideal candidate has a Nursing degree with active license, 5+ years in healthcare auditing, and relevant coding certifications (RHIA/RHIT/CCS/CIC/CCDS/CPC).

Qualifications

Associates or Bachelor's degree in Nursing (active/unrestricted license).
5+ years of healthcare auditing or quality assurance experience.
Active nursing license and coding certifications required.

Responsibilities

Performs clinical quality assurance review of daily clinical validation reviews.
Communicates with initial auditor to resolve differing decisions.
Integrates auditing principles and uses objectivity in performance of medical audit activities.
Reviews medical records to determine medical necessity and potential issues.
Mentor QA auditors.
May flex into initial audit or appeals role as needed.

Skills

Healthcare auditing

Mentoring

Communication

Attention to detail

Teamwork

Education

Nursing degree

Active nursing license

Medical coding certifications

Tools

Microsoft Office Suite

Job description

The ideal candidate has a Nursing degree with active license, 5+ years in healthcare auditing, and relevant coding certifications (RHIA/RHIT/CCS/CIC/CCDS/CPC).

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