Medical Review Auditor – Fraud Waste and Abuse

Cotiviti

Medical Reviewer auditing medical records to evaluate accuracy for Fraud, Waste & Abuse clients. Conducting compliance audits and creating detailed reports to improve practices.

Posted 6/19/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $70,000 - $91,000 per yearWebsite

About the role

Key responsibilities & impact

Conducts audit of medical records and healthcare claims assessing the accuracy of medical coding and determining compliance with appropriate policies, procedures, and regulations
Prepares and submits detailed reports on audit findings making recommendations to correct deficiencies and/or practice or process improvements
Conducts medical policy and other relevant research in support of review findings
Uses knowledge of healthcare coding conventions, areas of vulnerability, reimbursement methodologies, and the ability to identify suspicious patterns in medical record documentation
Maintains current knowledge of federal, state, and individual payer policy and coding guidelines
Participates in special projects as required

Requirements

What you’ll need

Bachelor’s Degree in a related discipline, or the equivalent combination of education, professional training, and work experience
Preferred licenses: Licensed Practical Nurse (LPN), Registered Nurse (RN)
Required Credential: Certified Professional Coder (CPC, CCS, CCS-P)
2-5 years of related experience in auditing medical records
Computer proficiency in MS Office suite
Excellent verbal and written communication skills
Strong listening and observation skills
Attention to detail and a high level of accuracy
Effective organizational and prioritization skills with multi-tasking ability
Understanding of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state guidelines (including CMS NCCI)
Healthcare claims experience helpful
Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program.

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

medical codingauditingICDCPTHCPCSAPCDRGRevenue CodesNCDsCMS NCCI

Soft Skills

verbal communicationwritten communicationlistening skillsattention to detailorganizational skillsprioritization skillsmulti-tasking ability

Certifications

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Coding Specialist - Physician-based (CCS-P)