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. This is a temporary role and can filled by a nurse or a coder. This position is direct hire and we expect will last at least 6 months. This position can be worked remotely from home anywhere in the US.
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 federal, state and individual payer policy and coding guidelines.
Participates in special projects as required.
Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience
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 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
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
Certified Professional Coder (CPC)
Clinical Documentation Specialist (CCDS)
Certified in Healthcare Compliance
This is a work at home position (US only). Access to high speed internet is required (all other equipment will be provided).
Must be able to sit and use a computer keyboard for extended periods of time
Must have ability to positively handle/manage stress, such as high work volume and frequent change.
For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities