Medical Review Auditor (Fraud Waste and Abuse) in USA

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. #senior #LI-JB1 #LI-Remote Expected salary: $61000 - 83000 per year Location: USA Job date: Sun, 17 Sep 2023 04:06:25 GMT Apply for the job now! Apply tot his job Apply tot his job