Medical Review Auditor – Fraud Waste and Abuse

Cotiviti

Medical Review Auditor auditing medical records and healthcare claims for Cotiviti’s Fraud, Waste & Abuse clients. Evaluating coding accuracy, policy compliance, and suspicious documentation patterns.

Posted 8/23/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $70,000 - $91,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding accuracy and compliance, with a strong understanding of healthcare coding conventions and reimbursement methodologies. Proficient in auditing medical records and preparing detailed reports while maintaining attention to detail and effective organizational skills.

Highest-signal resume keywords

Certified Professional Coder (CPC, CCS, CCS-P)Medical Record AuditingICD, CPT, HCPCS, APC, DRG KnowledgeMS Office ProficiencyHealthcare Claims Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Coding AccuracyAudit ReportingHealthcare Policy ResearchAttention to DetailReimbursement MethodologiesFederal and State GuidelinesCoding ConventionsDocumentation PatternsMulti-tasking AbilityOrganizational Skills

Soft Skills

Verbal CommunicationWritten CommunicationListening SkillsStress ManagementCollaboration

Certifications & Qualifications

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

Industry Keywords

Medical RecordsHealthcare ClaimsCMS NCCIRevenue CodesNCDsState and Federal GuidelinesLicensed Practical Nurse (LPN)Registered Nurse (RN)

About the role

Key responsibilities & impact

Audit medical records and healthcare claims to assess medical coding accuracy and compliance with policies, procedures, and regulations
Prepare and submit detailed reports on audit findings
Make recommendations to correct deficiencies and improve practices or processes
Conduct medical policy and relevant research to support review findings
Apply knowledge of healthcare coding conventions, vulnerabilities, reimbursement methodologies, and suspicious documentation patterns
Maintain current knowledge of federal, state, and individual payer policy and coding guidelines
Participate in special projects as required

Requirements

What you’ll need

Bachelor’s Degree in a related discipline, or equivalent combination of education, professional training, and work experience
Required credential: Certified Professional Coder (CPC, CCS, CCS-P)
Preferred licenses: Licensed Practical Nurse (LPN) and Registered Nurse (RN)
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
Ability to conduct research in support of medical review determinations
Understanding of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state guidelines, including CMS NCCI
Healthcare claims experience helpful
Ability to work independently and collaborate well with peers and customers
Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
Ability to positively handle/manage stress, including high work volume and frequent change
Must be able to provide a dedicated, secure work area
Access to high-speed internet is required

Benefits

Comp & perks

Medical insurance coverage
Dental insurance coverage
Vision insurance coverage
Disability insurance coverage
Life insurance coverage
401(k) savings plan
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on level and length of service
Work-at-home arrangement
Dedicated, secure work area
High-speed internet access required; all other equipment will be provided