[Hiring] Medical Review Auditor @Cotiviti

Role Description

As a Medical Reviewer, you will be auditing medical records to evaluate the accuracy of medical coding and health plan policies for our Fraud, Waste & Abuse clients.

• Conducts audit of medical records and healthcare claims assessing the accuracy of medical coding and determining compliance with appropriate policies, procedures, and regulations.
• Prepares and submits detailed reports on audit findings making recommendations to correct deficiencies and/or practice or process improvements.
• Conducts medical policy and other relevant research in support of review findings.
• Uses knowledge of healthcare coding conventions, areas of vulnerability, reimbursement methodologies, and the ability to identify suspicious patterns in medical record documentation.
• Maintains current knowledge of federal, state, and individual payer policy and coding guidelines.
• Participates in special projects as required.

Qualifications

• Bachelor’s Degree in a related discipline, or the equivalent combination of education, professional training, and work experience.
• Preferred licenses: Licensed Practical Nurse (LPN), Registered Nurse (RN).
• Required Credential: Certified Professional Coder (CPC, CCS, CCS-P).
• 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.
• Works independently; collaborates 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.

Requirements

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Must have the ability to positively handle/manage stress, such as high work volume and frequent change.

Physical Requirements and Working Conditions

• This is a work-at-home position (US only).
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Access to high-speed internet is required (all other equipment will be provided).
• No adverse environmental conditions are expected.

Benefits

• Base compensation ranges from $70,000 to $91,000 per year.
• Competitive benefits package including 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.