Senior Appeals Auditor — Remote & AI-Enabled

Cotiviti; United States; Remote; USD 66,000 - 79,000; Full time

Benefits offered by this job

Bonus potential

Job summary

Cotiviti is seeking a Senior Auditor, Appeals to defend recovery determinations across SNF, IRF, Home Health, DME, and Hospice claims. You will review medical records, apply CMS guidelines, and write detailed appeal responses.

The role requires RN licensure, 5+ years in healthcare auditing, and strong communication. Remote work within the continental US is supported; AI tools are used with professional judgment.

Qualifications

• RN license active/unrestricted.
• Five+ years in healthcare auditing with SNF/IRF/Home Health/DME/Hospice.
• Experience with appeals, provider communications, and CMS-based guidelines.

Responsibilities

• Review appealed claims with medical chart coding principles and guidelines.
• Substantiate appeal conclusions with clinical evidence and industry knowledge.
• Write clear, well-supported, claim-specific appeal responses.
• Maintain productivity and quality standards for appeals work.
• Assist QA and training with based on appeal determinations.
• Prepare case summaries and timelines for hearings.

Skills

Healthcare auditing

Medical record review

Coding guidelines

CMS/MAC knowledge

AI in audits

Written communication

Attention to detail

Education

Active RN license

Nursing degree

Tools

Word

Excel

Access

Cotiviti encoder/audit tools

Job description

Cotiviti is seeking a Senior Auditor, Appeals to defend recovery determinations across SNF, IRF, Home Health, DME, and Hospice claims. You will review medical records, apply CMS guidelines, and write detailed appeal responses.

The role requires RN licensure, 5+ years in healthcare auditing, and strong communication. Remote work within the continental US is supported; AI tools are used with professional judgment.