This auditing role focuses on coding and clinical chart validation for inpatient audits. The ideal candidate will have both clinical nursing and coding/auditing experience, with a background in inpatient DRG/APR-DRG and/or episode-of-care reviews. The position is responsible for auditing inpatient claims and documenting audit results with an emphasis on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.
The position will start on October 5, 2026 and includes scheduled group training for the first 12 weeks.
Responsibilities
- Analyze and audit claims using medical chart coding principles, clinical guidelines, and objectivity.
- Use advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to support audit conclusions.
- Perform medical record review and/or episode-of-care review as needed.
- Use Cotiviti proprietary auditing systems to make audit determinations and generate audit letters.
- Meet or exceed productivity goals established by audit operations management.
- Meet or exceed accuracy and quality standards for valid claim identification and documentation.
- Identify potential claim types outside of the current concept where additional recoveries may be available.
- Suggest and develop high-value concept or process improvements, tools, and related enhancements.
- Complete all responsibilities outlined in annual performance reviews and/or goal setting.
- Complete special projects and other duties as assigned.
- Perform duties with or without reasonable accommodation.
Requirements & Qualifications
Qualifications
Education
- Associate or bachelor’s degree in nursing with an active, unrestricted license.
- Associate or bachelor’s degree in Health Information Management with RHIA or RHIT.
- Licensed Practical Nurse (LPN) with an active, unrestricted license.
Coding/CDI Certification
- One of the following certifications, maintained as a condition of employment:
- RHIA or RHIT
- CPC or COC
- Inpatient coding credential such as CCS, CIC, CDIP, or CCDS
- Candidates without a current coding credential must obtain one within 6 months of hire.
Experience and Skills
- 2 years of prior clinical and/or coding experience preferred.
- Basic to intermediate knowledge of medical and coding terminology.
- Working knowledge of medical claims billing/payment systems and provider billing guidelines preferred.
- Working knowledge of applicable industry standards.
- Proficiency in Word, Access, Excel, TEAMS, and other applications.
- Excellent written and verbal communication skills.
Working Conditions
- Ability to remain stationary for prolonged periods.
- Ability to repeat motions involving wrists, hands, and/or fingers.
- Ability to provide a dedicated, secure work area.
- Ability to provide high-speed internet access/connectivity and maintain a home office setup.
Benefits & Perks
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Disability insurance
- Life insurance
- 401(k) savings plan
- Paid family leave
- 9 paid holidays per year
- 17–27 days of PTO per year, depending on level and length of service
- Eligible for discretionary bonus consideration
- Overtime eligible as a nonexempt role
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago
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