Medical Review Auditor (Fraud Waste and Abuse) - Cotiviti - USA - work from home job
Company: Cotiviti
Job description: Responsibilities
• 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
• Education & Certifications:
• 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
Work Environment
• 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 the ability to positively handle/manage stress, such as high work volume and frequent change.
Base compensation ranges from $61,000 to $83,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
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Expected salary: $61000 - 83000 per year
Location: USA
Job date: Sun, 17 Sep 2023 04:06:25 GMT
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