Cotiviti · 1 month ago
DRG Validation Auditor (Clinical & Coding)
United States
Full-time
Remote
Senior Level
$45.67/hr - $45.67/hr
5+ years expCotiviti is a healthcare auditing company, and they are seeking a DRG Validation Auditor to focus on Coding & Clinical Chart Validation for inpatient audits. The role involves auditing inpatient claims, ensuring coding accuracy, and documenting audit results while utilizing proprietary auditing systems.
Information Technology & Services
Responsibilities
Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in 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 concept and or process improvement, tools, etc
Complete all responsibilities as outlined on annual Performance Plan
Complete all special projects and other duties as assigned
Must be able to perform duties with or without reasonable accommodation
Qualification
Required
Associate or bachelor's degree in nursing (active /unrestricted license)
Associate or bachelor's degree Health Information Management (RHIA or RHIT)
High school diploma or GED plus 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
RHIA or RHIT certification
CPC certification
Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
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, APRDRG, ICD-10, CPT, HCPCS codes
Requires working knowledge of and applicable industry-based standards
Proficiency in Word, Access, Excel, TEAMS, and other applications
Excellent written and verbal communication skills
Communicating with others to exchange information
Assessing the accuracy, neatness, and thoroughness of the work assigned
Remaining in a stationary position, often standing or sitting for prolonged periods
Repeating motions that may include the wrists, hands, and/or fingers
Must be able to provide a dedicated, secure work area
Must be able to provide high-speed internet access/connectivity and office setup and maintenance
No adverse environmental conditions expected
Benefits
Medical
Dental
Vision
Disability
Life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.
Company
Cotiviti
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.
5001-10000 employees
H1B Sponsorship
Cotiviti has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
1%
Represents job field similar to this job
Accounting and Finance
Engineering and Development
Management and Executive
Product Management
Customer Service and Support
Arts and Entertainment
Creatives and Design
Marketing
Trends of Total Sponsorships
*2026 (72)
2025 (164)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
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