Auditor, Clinical Validation, Outpatient Specialty

Cotiviti

Auditor focusing on Coding & Clinical Chart Validation for Cotiviti audits. Responsibilities include auditing outpatient/specialty claims and documenting the results.

Posted 5/21/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $95,600 per yearWebsite

About the role

Key responsibilities & impact

Audits Outpatient and Specialty Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims.
Draws on advanced coding expertise and industry knowledge to substantiate conclusions.
Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues.
Effectively Utilizes Audit Tools: Utilizes advanced proficiency, Cotiviti encoder and audit tools required to perform duties.
Meets or Exceeds Standards/Guidelines for Quality: A chieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
Identifies New Claim Types: Identifies potential claims outside of the concept where additional recoveries may be available.
Recommends New Concepts and Processes: Has broad in-depth knowledge of client, contract terms and complex claim types gained from extensive healthcare auditing experience.
Suggests, develops and implements new ideas, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction.

Requirements

What you’ll need

Associate or bachelor’s degree in nursing (active /unrestricted license)
Coding Certification required and maintained i.e. CPC, CIC, CCS, CCS-P, RHIA or RHIT
5 to 7 years of experience with clinical medical record coding or auditing
Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
A broad knowledge of medical claims billing/payment systems provider billing guidelines
Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates
Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes
Excellent verbal and written communication skills.
Ability to work well in an individual and team environment.

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

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Hard Skills & Tools

medical chart codingauditingcoding principlesbilling/coding issuesDRGICD-10CPTHCPCSmedical claims billingcoding guidelines

Soft Skills

communication skillsindependent workteamworkproblem-solvinganalytical skillsattention to detailadaptabilitycreativityclient satisfactionprocess improvement

Certifications

CPCCICCCSCCS-PRHIARHIT