Job title: Auditor – Clinical Validation
Company: Cotiviti
Job description: Overview
JOB RESPONSIBILITIES
- Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
- Respond to provider appeals.
- Respond to client logics and record reviews.
- Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
- Reports his/her work performance on a timely basis to the team lead.
- Works diligently to meet and exceed productivity and quality benchmarks.
- Takes charge of ongoing learning and development and participates in relevant training and development activities.
- Willing to work in US hours during training, which may last for 8 to 12 weeks. Thereafter shift timing will overlap US working hours for couple of hours (shift timing anytime between 7:00am – 10:00pm IST), based on business requirements.
- Required to be available in the office for training and first few weeks of go-live, depending on the future pandemic conditions as well as company’s ability to resume operations from an office setting.
ATTRIBUTES AND BEHAVIORS
- Develops and maintains positive working relationships with others
- Shares ideas and information Ability to collaborate efficiently.
- Assists colleagues unprompted
- Takes pride in the achievement of team objectives
- Has credibility with peers and senior managers
- Self-motivated – driven to achieve results
- Works with a sense of urgency
- High customer service ethic – is passionate about meeting customer expectations and improving service levels
- Keeps pace with change – acquires knowledge/skills as the business evolves
- Handles confidential information with sensitivity.
- Exhibits behaviors consistent with Cotiviti Values:
- Integrity
- Passionate Client Service
- Teamwork
- Accountability
- Performance Excellence
- Continuous Improvement
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
- Medical degree (MBBS or BAMS or BHMS or BPT) with CPC/CIC/CCS certification and prior auditing/DRG experience preferred.
- Medical coders with CIC or CCS certification with prior DRG experience (at least 1-2 years experience)
- Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
- Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
- Practical clinical experience working in a hospital/office or nursing home strongly preferred.
- Has general knowledge of medical procedures, conditions, illnesses, and treatment practices.
- Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
- Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
SKILLS & COMPETENCIES
- Strong analytical, critical thinking and problem-solving skills
- Excellent verbal and written communication skills
- Be a quick learner and proficient in application of learnings
- Excel proficiency
- Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
- Ability to work well independently and maintain focus on a topic for prolonged periods of time
Expected salary:
Location: Coimbatore, Tamil Nadu
Job date: Sun, 25 Sep 2022 00:40:47 GMT
Apply for the job now!