Performs clinical quality assurance review of daily clinical validation reviews
The quality auditor will be responsible for communicating with the initial auditor when there are differing decisions on the audit to ensure that the final decision is supported and as accurate as possible
Integrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review
Utilizes industry knowledge and proficiency in healthcare to substantiate decisions
Performs work independently and reviews work of others
Depending on nature and scope of audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns
May serve as a mentor to other QA auditors or initial auditors
Depending on the business needs, may also flex into the initial audit role and/or the appeals role as needed

Associates or Bachelor's degree in Nursing (active/unrestricted license)
Equivalent experience of 5+ years experience in claims auditing, quality assurance, or recovery auditing
ideally in a Clinical Validation Audit setting or a hospital environment
Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)
RHIA or RHIT. Inpatient Coding Credential
CCS or CIC preferred
Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company
3-5 years of healthcare auditing or related experience
Ability to mentor staff and enhance performance as it relates to the quality and productivity of auditors
Excellent verbal and written communication skills
Ability to work well in an individual and team environment
Computer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint, etc.)

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

Senior Auditor, Quality

Key skills