Key skills
Communication
About this role
Role Overview
- Performs clinical quality assurance review of daily clinical validation reviews
- Responsible for communicating with the initial auditor on differing decisions
- 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
- Reviews medical records and applies in-depth knowledge of clinical criteria to determine medical necessity
Requirements
- Associates or Bachelor's degree in Nursing (active/unrestricted license)
- Equivalent experience of 5+ years in claims auditing, quality assurance, or recovery auditing
- Coding Certification (at least one of the following: RHIA or RHIT)
- Inpatient Coding Credential
- CCS or CIC preferred
- 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
- Computer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint, etc.)
Benefits
- 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.