- Associates Degree or equivalent relevant experience required. Bachelor’s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business, preferred, or 5 – 7 years of relevant experience (experience in any of the following: claims auditing/quality assurance/recovery auditing).
- Clinical /Nursing experience in an inpatient or specialty (SNF, DME, etc.) setting is a plus.
- Coding certification is required and maintained as a condition of employment. (CCS, CPC, etc.). Candidates who hold a CCDS will also be given consideration but will need to obtain a coding certification within 6 months.
- 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
- Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
- Strong presentation skills. Comfortable in presenting/defending audit logic to clients and key stakeholders (i.e. hospitals, physicians, validation contractors, auditing team, etc.).
- Independent thinker, logical, strategic, with a high focus and attention to detail.
- Effective communication and presentation style (written and verbal) with proven ability to positively influence behavior and outcomes.
- Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
- Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines.
- Professional demeanor: Ability to creatively solve problems, deal with ambiguity, develop and implement policy and procedures, perform analysis and prepare reports, and foster team building.
- High level of proficiency with all audit technology i.e., R3, CAT, etc.
- Proficiency in Word, Access, Excel, PowerPoint and other applications.
- Excellent written and verbal communication skills.
Mental Requirements:
- Communicating with others to exchange information.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
Physical Requirements and Working Conditions:
- 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.
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
- No adverse environmental conditions are expected.
Base compensation is $99,000. 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.
Date of posting: 08/12/2024
Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/12/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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