Auditor, Clinical Validation, OPSP Coding

Cotiviti

. Audit outpatient and specialty claims .

Posted 9/21/2026full-timeRemote • United StatesMid-LevelSenior💰 $46 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding and auditing, with a strong understanding of DRG, ICD-10, CPT, and HCPCS codes. Proficient in applying coding principles and client-specific guidelines to ensure compliance and enhance audit processes.

Highest-signal resume keywords

Coding Certification (CPC, CIC, CCS, CCS-P, RHIA, RHIT)5-7 Years Experience in Clinical Medical Record Coding or AuditingExpert Knowledge of DRG, ICD-10, CPT, and HCPCS CodesWorking Knowledge of HIPAA Privacy and Security RulesBroad Knowledge of Medical Claims Billing/Payment Systems

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Chart CodingClaims AuditingDRG CodingICD-10 CodingCPT CodingHCPCS CodingClaims EntryCoding Guidelines AdherenceBilling Guidelines KnowledgeRegulatory Compliance

Soft Skills

Excellent Verbal CommunicationExcellent Written CommunicationIndependent Work AbilityTeam Collaboration

Tools & Technologies

Cotiviti EncoderCotiviti Audit ToolsCotiviti System

Certifications & Qualifications

CPCCICCCSCCS-PRHIARHIT

Industry Keywords

Medical ClaimsPayer Reimbursement PoliciesMedical Necessity CriteriaCoding TerminologyCMS Security Requirements

About the role

Key responsibilities & impact

Audit outpatient and specialty claims
Apply medical chart coding principles and client-specific guidelines to outpatient, pharmacy, and/or inpatient DRG claims
Use advanced coding expertise and industry knowledge to substantiate audit conclusions
Independently review and interpret medical records to identify billing and coding issues
Use Cotiviti encoder and audit tools
Enter claims accurately into the Cotiviti system according to standard procedures
Meet productivity, accuracy, quality, and production standards
Identify potential claims outside the assigned audit concept where additional recoveries may be available
Suggest and develop high-quality, high-value audit concepts, process improvements, and tools
Apply knowledge of client requirements, contract terms, and complex claim types
Suggest, develop, and implement ideas, approaches, and technological improvements to enhance audit production, communication, and client satisfaction
Evaluate information and draw logical conclusions
Complete responsibilities in the annual Performance Plan
Complete special projects and other assigned duties

Requirements

What you’ll need

Associate or bachelor’s degree in Health Information Management (RHIA or RHIT), or equivalent combination of relative work experience
Coding certification required and maintained, such as CPC, CIC, CCS, CCS-P, RHIA, or RHIT
5 to 7 years of experience with clinical medical record coding or auditing
Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
Ability to become proficient in various outpatient and specialty review types
Adherence to official coding guidelines, Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates
Expert knowledge of DRG, ICD-10, CPT, and HCPCS codes
Excellent verbal and written communication skills
Ability to work independently and in a team environment
Ability to provide a dedicated, secure work area
Ability to provide high-speed internet access/connectivity and office setup and maintenance
Ability to perform duties with or without reasonable accommodation

Benefits

Comp & perks

Discretionary bonus consideration
Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plan
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
Overtime pay for nonexempt employees for hours worked in excess of 40 hours in a week, or as required by applicable state law
Remote work arrangement
Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the employee