Cotiviti Looking for Auditor, DRG Coding & Clinical Validation at United States Full Time

Full Job Description

Overview:

The Auditor, DRG Coding & Clinical Validation
position has an extensive background in either facility-based nursing,
clinical documentation, and/or inpatient coding and has a high level
of understanding in reimbursement guidelines specifically an
understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This
position is responsible for auditing inpatient medical records and
generating high quality recoverable claims for the benefit of Cotiviti
and our clients. Responsible for performing clinical reviews of
medical records and other documentation to evaluate issues of coding
and DRG assignment accuracy.

Responsibilities:

Analyzes and Audits Claims. Integrates medical chart coding
principles, clinical guidelines, and objectivity in the performance of
medical audit activities. Draws on advanced ICD-10 coding expertise,
clinical guidelines, and industry knowledge to substantiate
conclusions. Performs work independently.

Effectively
Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems
with a high level of proficiency to make audit determinations and
generate audit letters.

Meets or Exceeds
Standards/Guidelines for Productivity. Maintains production goals set
by the audit operations management team.

Meets or Exceed
Standards/Guidelines for Accuracy and Quality. Achieves the expected
level of accuracy and quality set by the audit for the auditing
concept, for valid claim identification and documentation (letter
writing).

Identifies New Claim Types. Identifies potential
claims outside of the concept where additional recoveries may be
available. Suggests and develops high-quality, high-value concepts and
or process improvement, tools, etc.

Qualifications:
Education (at least one of the following is required)-
Associates or Bachelor’s degree in Nursing (active/unrestricted
license)
Associate or Bachelor’s degree in Health Information
Management (RHIA or RHIT)
Equivalent experience of 5+ years
experience in claims auditing, quality assurance, or recovery
auditing…ideally in a DRG / Clinical Validation Audit setting or a
hospital environment.
Coding Certification (at least one of the
following are required and are to be maintained as a condition of
employment)
RHIA or RHIT
Inpatient Coding Credential – CCS
or CIC preferred
Candidates who hold a CCDS or CPC will be given
consideration but will need to obtain an inpatient coding
certification within 1 year of their hire date with the company.
Experience (required)
5 to 7+ years of working with ICD-9/10CM,
MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims
billing/payment systems provider billing guidelines, payer
reimbursement policies, medical necessity criteria, and coding
terminology.
Adherence to official coding guidelines, coding
clinic determinations, and CMS and other regulatory compliance
guidelines and mandates. Requires expert coding knowledge – DRG &
ICD-10.
Requires working knowledge of applicable industry-based
standards.
Proficiency in Word, Access, Excel, and other
applications.
Excellent written and verbal communication
skills.

Work Environment:

This is an at
home-based position and you must have a work location within the
continental US
This position requires that you provide a
high-speed internet connection and a work environment free from
distractions (all other equipment will be provided by the company).
This role is aligned to certain productivity and quality
requirements
Must be able to sit and use a computer keyboard for
extended periods of time
Must have flexibility and willingness to
participate in the work processes of an international organization,
including conference calls scheduled to accommodate global time
zones.

Base compensation is paid hourly at $44.23/hour (92k
annualized). Specific offers are determined by various factors, such
as experience, education, skills, certifications, and other business
needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to
address a wide range of personal and family needs, including medical,
dental, vision, disability, and life insurance coverage, 401(k)
savings plans, paid family leave, 9 paid holidays per year, and 17-27
days of Paid Time Off (PTO) per year, depending on specific level and
length of service with Cotiviti. For information about our benefits
package, please refer to our Careers page.

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