Cotiviti

Clinical Consultant I

Cotiviti

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $80,000 - $95,000 per year

About the role

  • Support Clinical Services teams in the validation of quality and processes consistency on the CPE editing engine
  • Provide support and subject matter expertise on Coding Validation (CV)
  • Act as a liaison for clinical information between internal partners and external customers
  • Provide resources to facilitate client understanding of Coding Validation policies and concepts
  • Review and analyze CV related client inquiries and Change Requests for clarity of intent
  • Collaborate with Client Teams to develop and maintain excellent client relationships
  • Support CPE Clinical Services quality assurance processes including pre and post release testing
  • Maintain Client Information Workbooks with updated information as needed for CV review

Requirements

  • Associate or Bachelor’s degree in Nursing (active/unrestricted license)
  • Registered Nursing license (RN) – active and unrestricted in state of residence
  • Professional coder certification (CPC, CPC-H, CPC-P, or CCS-P), RHIT or RHIA certification required
  • 2+ years of clinical experience as a Registered Nurse
  • 1+ years of experience in Coding Validation
  • 1+ years of experience in coding including professional and outpatient facilities
  • 1+ years of experience in claims adjudication, medical/payment policy, or utilization review
  • 1+ years of experience in customer service or client management with a strong focus on healthcare setting
  • Ability to analyze complex data
  • Strong research capabilities and knowledge of CMS guidelines and regulatory compliance guidelines
  • Proficient with Microsoft Office Suite (Word, Excel, Power Point)
  • Ability to work well independently and in a collaborative team environment
Benefits
  • medical, dental, vision, disability, and 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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Coding Validationclinical experienceclaims adjudicationmedical/payment policyutilization reviewdata analysisresearch capabilitiesCMS guidelinesregulatory compliancecoding
Soft Skills
client managementcommunicationcollaborationrelationship buildingindependent workteamworkproblem-solvingcustomer serviceanalytical thinkingfacilitation
Certifications
Registered Nursing license (RN)Professional coder certification (CPC)Professional coder certification (CPC-H)Professional coder certification (CPC-P)Professional coder certification (CCS-P)RHIT certificationRHIA certification