General Summary:
We are currently seeking Auditor to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Auditor is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements.
Principal Duties/ 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 9:00am – 1:30am Philippines time), based on business requirements
- Required to work from office
- Works effectively in co-ordination with India team
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.
Skills and 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
Experience requirements:
- Registered Nurses) with CIC/CCS certification and prior auditing/DRG experience preferred
- 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
- Exhibit behavior consistent with Cotiviti Values
- Customer Driven
- Collaborative
- Accountable
- Open
