{"id":465514,"url":"https://alion.io/job/cotiviti-auditor-clinical-validation-drg","title":"Auditor Clinical Validation DRG","company":{"id":706,"name":"Cotiviti","domain":"cotiviti.com","url":"https://alion.io/company/cotiviti","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"iCIMS","truth_index":null},"role":"Finance","role_family":"Finance","seniority":"senior","employment_type":null,"work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"inferred","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":45670,"max":null,"currency":"USD","period":"year","gross":null,"usd_annual":45670},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-09-06T12:11:13Z","employer_posted_date":"2026-09-10","last_verified_at":"2026-11-04T04:03:22Z","board_verified":true,"closed_at":null,"days_open":58,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":58},"description":"Overview\nThis auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.\nResponsibilities\nAnalyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.\nEffectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.\nMeets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team.\nMeets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim.\nidentification and documentation (letter writing).Identifies New Claim Types. \nIdentifies potential claims outside of the concept where additional recoveries may be available.\n Suggests and develops high quality, high value concept and or process improvement, tools, etc.\nComplete all responsibilities as outlined on annual Performance Plan.\nComplete all special projects and other duties as assigned.\nMust be able to perform duties with or without reasonable accommodation.\nComplete all responsibilities as outlined on annual Performance Plan.\nComplete all special projects and other duties as assigned.\nMust be able to perform duties with or without reasonable accommodation.\nThis job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.\nQualifications\nEducation (at least one of the following are required):\nAssociate or bachelor’s degree in nursing (active /unrestricted license).\nAssociate or bachelor’s degree Health Information Management (RHIA or RHIT).\nHigh school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment.\nCoding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment):\nRHIA or RHIT.\nCPC.\nInpatient Coding Credential - CCS, CIC, CDIP or CCDS.\nExperience (required):\n5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.\nAdherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes.\nRequires working knowledge of and applicable industry-based standards.\nProficiency in Word, Access, Excel, TEAMS, and other applications.\nExcellent written and verbal communication skills.\nMental Requirements:\nCommunicating with others to exchange information.\nAssessing the accuracy, neatness, and thoroughness of the work assigned.\nPhysical Requirements and Working Conditions:\nRemaining in a stationary position, often standing or sitting for prolonged periods.\nRepeating motions that may include the wrists, hands, and/or fingers.\nMust be able to provide a dedicated, secure work area.\nMust be able to provide high-speed internet access/connectivity and office setup and maintenance.\nNo adverse environmental conditions expected.\nBase compensation is paid hourly at $45.67 per hour (95k annualized). This role is eligible for discretionary bonus consideration.\nNonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.\nCotiviti 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.\nDate of posting: 8/24/2026\nApplications are assessed on a rolling basis. We anticipate that the application window will close on 10/31/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.\n#senior","description_format":"text","description_chars":5240,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":false},"security_clearance":false,"languages":[]},"benefits":["Insurance coverage","Life insurance","Parental leave"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Revenue Cycle & Medical Billing","Health Data & Interoperability"],"lifecycle":[{"event":"open","at":"2026-09-06T12:11:13Z"}],"visa":[{"country":"US","licensed_sponsor":true,"evidence":"H-1B filings in 12 months: 187 · green card filings: 35","filings_12m":187,"filings_prev_12m":141,"green_card_filings_12m":35,"median_offered_wage_usd":133288,"route":null,"cap_exempt":false,"checked_at":"2026-10-29T16:27:21+00:00","sources":["US Department of Labor: LCA disclosure data (H-1B, H-1B1, E-3)","US Department of Labor: PERM disclosure data (green cards)"],"filings_for_role_12m":0}],"liveness":{"score":13,"band":"cold","label":"Long shot","p_open":1,"p_active":0.375,"p_room":0.35,"age_days":58,"expected_fill_days":10,"reasons":["conf:2","urgency","velocity","win:tail"],"computed_at":"2026-11-04T06:34:25Z"},"pay":{"stated_usd_annual":45670,"is_top_pay":false},"html_url":"https://alion.io/job/cotiviti-auditor-clinical-validation-drg","json_url":"https://alion.io/job/cotiviti-auditor-clinical-validation-drg.json","meta":{"generated_at":"2026-11-04T06:40:43Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":10421,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-05T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":706},"rest":"https://alion.io/mcp/rest/get_company?id=706"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fcotiviti-auditor-clinical-validation-drg"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fcotiviti-auditor-clinical-validation-drg"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fcotiviti-auditor-clinical-validation-drg"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/cotiviti-auditor-clinical-validation-drg\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcotiviti-auditor-clinical-validation-drg"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":465514}},{"tool":"search_jobs","arguments":{"company":"cotiviti.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":465514},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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