Associate Auditor, Clinical Validation, DRG

Cotiviti

Auditor responsible for Clinical Chart Validation in remote healthcare audits focusing on inpatient claims. Integrating coding principles and clinical guidelines for accurate audit determinations.

Posted 4/28/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $31 - $38 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

Associate or bachelor’s degree in nursing (active /unrestricted license)
Associate or bachelor’s degree Health Information Management (RHIA or RHIT)
Licensed Practical Nurse (LPN) (active /unrestricted license)
Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment): RHIA or RHIT, CPC or COC, Inpatient Coding Credential – CCS, CIC, CDIP or CCDS
2 years of prior clinical and/or coding experience is preferred
Basic to Intermediate knowledge of medical and coding terminology
Working knowledge of medical claims billing/payment systems and provider billing guidelines is preferred
Requires working knowledge of and applicable industry-based standards
Proficiency in Word, Access, Excel, TEAMS, and other applications
Excellent written and verbal communication skills.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10 codingmedical chart codingauditingclaim identificationdocumentationmedical terminologycoding terminologymedical claims billingprovider billing guidelinesprocess improvement

Soft Skills

independenceproductivityaccuracyqualitycommunication

Certifications

RHIARHITCPCCOCCCSCICCDIPCCDS