Auditor Clinical Validation OPSP Coding

Cotiviti • Remote, US • published 2026-09-22 16:42:36.719802

Description

Overview: This auditing role will focus on Coding \& Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical and a coding/auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered. Responsibilities: **Audits Outpatient and Specialty Claims*** Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims. * Draws on advanced coding expertise and industry knowledge to substantiate conclusions. * Performs work independently, reviews and interprets medical records and applies in\-depth knowledge of coding principles to determine potential billing/coding issues. **Effectively Utilizes Audit Tools*** Utilizes advanced proficiency, C...

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