Auditor Clinical Validation, Place of Service, Short Stay, Readmission

Cotiviti

Auditing clinical claims for Cotiviti's healthcare services, ensuring compliance with clinical guidelines and accuracy requirements. Integrating medical chart evaluations and maintaining productivity standards in remote setting.

Posted 5/2/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $45,667 per hourWebsite

About the role

Key responsibilities & impact

Analyzes and Audits Claims
Integrates medical chart severity of illness and intensity of service based on clinical guidelines and objectivity in performance of medical audit activities
Effectively Utilizes Audit Tools
Meets or Exceeds Standards/Guidelines for Productivity
Meets or Exceeds Standards/Guidelines for Accuracy and Quality
Identifies New Claim Types
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

Requirements

What you’ll need

Associate or Bachelor's degree in nursing
RN License (active /unrestricted in state of residence)
Case Management Certification (preferred)
5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation)
Utilization Management and/or Case Management
Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg
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, depending on specific level and length of service with Cotiviti

ATS Keywords

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Applicant Tracking System Keywords

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

Hard Skills & Tools

medical auditclaims analysisInterQualMCGutilization managementcase managementcritical careprocess improvementproductivity standardsaccuracy and quality standards

Soft Skills

communicationanalytical skillsattention to detailproblem-solvingteam collaborationorganizational skillstime managementadaptabilityleadershipinterpersonal skills

Certifications

RN LicenseCase Management Certification