Clinical Analyst I

Cotiviti

Coding Validation Analyst I performing daily audits on client data for reimbursement accuracy. Requires RN license, coding certification, and work in a fast-paced environment with shifts.

Posted 7/14/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $34 - $38 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing client data for accuracy and completeness, with a strong understanding of coding and clinical practices to ensure compliance with reimbursement policies. Proficient in medical coding standards and regulations, with a focus on enhancing operational efficiency and meeting key performance indicators.

Highest-signal resume keywords

Registered Nurse LicenseCoding Certification (CPC, CCS, CCS-P)Claims Payment Policy KnowledgeMedical Procedures KnowledgeMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AuditingCoding AccuracyClinical BackgroundPatient Care ExperienceReimbursement Compliance

Soft Skills

Attention to DetailEffective CommunicationFeedback Provision

Certifications & Qualifications

Registered Nurse LicenseCoding Certification (CPC, CCS, CCS-P)NY Independent Insurance Adjuster Licensure

Industry Keywords

CMS RegulationsMedicaid RegulationsICD-10CPTHCPCS

About the role

Key responsibilities & impact

Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals
Respond to provider appeals and meet required client turnaround time and KPI goals
Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency
Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
Complete all responsibilities as outlined in the annual performance review and/or goal setting
Complete all special projects and other duties as assigned

Requirements

What you’ll need

Active professional license as a Registered Nurse in your current state of residence (BSN preferred)
2 years of professional experience in providing direct patient care
Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment
Required to obtain NY Independent Insurance Adjuster licensure within the first four months
Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices
Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Benefits

Comp & perks

Health insurance
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