[Hiring] Senior Auditor Quality @Cotiviti

Role Description

The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Audited claim types include:

• Outpatient
• Specialty Review Types (SNF, IRF, HH, DME, Hospice)
• Medical necessity

Quality assurance emphasizes compliance with established procedures, accuracy of claim identification, and supportive documentation. Responsibilities include:

• Performing clinical quality assurance review of daily clinical validation reviews.
• Communicating with the initial auditor when there are differing decisions on the audit.
• Integrating healthcare auditing principles and using objectivity in medical audit activities.
• Utilizing industry knowledge and proficiency in healthcare to substantiate decisions.
• Performing work independently and reviewing work of others.
• Reviewing medical records and applying in-depth knowledge of clinical criteria.
• Serving as a mentor to other QA auditors or initial auditors.
• Flexing into the initial audit role and/or the appeals role as needed.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• Associates or Bachelor's degree in Nursing (active/unrestricted license).
• 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 required):
• RHIA or RHIT
• Inpatient Coding Credential - CCS or CIC preferred
• CCDS or CPC will be considered but must obtain inpatient coding certification within 1 year of hire date.
• 3-5 years of healthcare auditing or related experience.
• Ability to mentor staff and enhance performance related to 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.).

Requirements

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Providing a dedicated, secure work area.
• Providing high-speed internet access/connectivity and office setup and maintenance.

Benefits

• Base compensation ranges from $47.00 to $56.00 per hour.
• Eligible for discretionary bonus consideration.
• Nonexempt employees are eligible for overtime pay for hours worked in excess of 40 hours in a given week.
• 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.