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Senior Auditor Quality – OPSP
CotivitiQuality Assurance Auditor conducting clinical quality assurance reviews and communicating on audit decisions for Cotiviti. Responsible for ensuring claims meet standards and identifying process improvement opportunities.
About the role
Key responsibilities & impact- Performs clinical quality assurance review of daily clinical validation reviews
- Responsible for communicating with the initial auditor on differing decisions
- Integrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review
- Utilizes industry knowledge and proficiency in healthcare to substantiate decisions
- Performs work independently and reviews work of others
- Reviews medical records and applies in-depth knowledge of clinical criteria to determine medical necessity
Requirements
What you’ll need- Associates or Bachelor's degree in Nursing (active/unrestricted license)
- Equivalent experience of 5+ years in claims auditing, quality assurance, or recovery auditing
- Coding Certification (at least one of the following: RHIA or RHIT)
- Inpatient Coding Credential - CCS or CIC preferred
- 3-5 years of healthcare auditing or related experience
- Ability to mentor staff and enhance performance as it relates to the quality and productivity of auditors
- Excellent verbal and written communication skills
- Computer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint, etc.)
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
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills & Tools
clinical quality assuranceclaims auditingquality assurancemedical auditclinical criteriacodinghealthcare auditingmedical necessityauditing principlesperformance review
Soft Skills
communicationobjectivityindependencementoringenhancing performanceverbal communicationwritten communication
Certifications
Associates degree in NursingBachelor's degree in NursingRHIARHITCCSCIC