Clinical Auditor, Outpatient Specialty

Cotiviti

Auditor focusing on Coding & Clinical Chart Validation for outpatient audits at Cotiviti. Responsible for auditing claims, ensuring coding accuracy, and documenting results.

Posted 6/19/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $45,600 per hourWebsite

About the role

Key responsibilities & impact

Audits Outpatient and Specialty Claims
Utilizes medical chart coding principles and client specific guidelines
Performs work independently, reviews and interprets medical records
Utilizes advanced proficiency, Cotiviti encoder and audit tools
Maintains production goals, accuracy and quality standards
Identifies potential claims outside of concept for additional recoveries
Suggests, develops and implements new ideas for audit production 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
Broad knowledge of medical claims billing/payment systems provider billing guidelines
Adherence to official coding guidelines and coding clinic determinations
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 insurance
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 chart codingclinical medical record codingauditingDRGICD-10CPTHCPCScoding guidelinesbilling/payment systemsclient specific guidelines

Soft Skills

independent workcommunication skillsteamworkproblem-solvingidea developmentclient satisfaction focusaccuracyquality standards adherenceproduction goal maintenanceinterpretation skills

Certifications

CPCCICCCSCCS-PRHIARHIT