{"id":3723602,"url":"https://alion.io/job/cotiviti-senior-auditor-quality-opsp","title":"Senior Auditor Quality - OPSP","company":{"id":706,"name":"Cotiviti","domain":"cotiviti.com","url":"https://alion.io/company/cotiviti","size_band":"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":"structured","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":47,"max":56,"currency":"USD","period":"hour","gross":null,"usd_annual":112000},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false},{"name":"Outlook","optional":false},{"name":"SharePoint","optional":false}],"status":"live","first_seen_at":"2026-11-04T04:03:22Z","employer_posted_date":"2026-11-04","last_verified_at":"2026-11-15T15:34:37Z","board_verified":true,"closed_at":null,"days_open":11,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":11},"description":"Overview\nThe Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Audited claim types include: Outpatient and Specialty Review Types to include SNF, IRF, HH, DME, Hospice and medical necessity. Quality assurance emphasizes compliance with established procedures, accuracy of claim identification and supportive documentation. Identifies and notifies management of observed quality and communicates opportunities for process improvements based on independent audit claims review. Displays professional skepticism that enhances the work performed in order to achieve success in position.\nResponsibilities\nPerforms clinical quality assurance review of daily clinical validation reviews. The quality auditor will be responsible for communicating with the initial auditor when there are differing decisions on the audit to ensure that the final decision is supported and as accurate as possible.\nIntegrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review.\nUtilizes industry knowledge and proficiency in healthcare to substantiate decisions.\nPerforms work independently and reviews work of others.\nDepending on nature and scope of audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns.\nMay serve as a mentor to other QA auditors or initial auditors.\nDepending on the business needs, may also flex into the initial audit role and/or the appeals role as needed.\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 requirements of the job change.\nQualifications\nEducationAssociates or Bachelor's degree in Nursing (active/unrestricted license).\nEquivalent experience of 5+ years experience in claims auditing, quality assurance, or recovery auditing...ideally in a Clinical Validation Audit setting or a hospital environment.\n\nCoding Certification (at least one of the following are required and are to be maintained as a condition of employment).RHIA or RHIT.\nInpatient Coding Credential - CCS or CIC preferred.\nCandidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company. \n\n3-5 years of healthcare auditing or related experience.\nAbility to mentor staff and enhance performance as it relates to the quality and productivity of auditors.\nExcellent verbal and written communication skills.\nAbility to work well in an individual and team environment.\nComputer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint, etc.).\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.\nBase compensation ranges from $47.00 to $56.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 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: 8/5/2026\nApplications are assessed on a rolling basis. We anticipate that the application window will close on 10/5/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.\n#LI-Remote#LI-JJ1#senior","description_format":"text","description_chars":4750,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","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":"2026-11-04T04:03:22Z"}],"visa":[{"country":"US","licensed_sponsor":true,"adverts_offering_sponsorship_24m":0,"sanctioned_now":false,"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":"2026-11-15T09:21:55+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":53,"band":"ok","label":"Likely open","p_open":1,"p_active":0.97,"p_room":0.55,"age_days":11,"expected_fill_days":10,"reasons":["conf:4","urgency","velocity","win:tail"],"computed_at":"2026-11-15T07:52:55Z"},"pay":{"stated_usd_annual":112000,"is_top_pay":false},"html_url":"https://alion.io/job/cotiviti-senior-auditor-quality-opsp","json_url":"https://alion.io/job/cotiviti-senior-auditor-quality-opsp.json","meta":{"generated_at":"2026-11-15T22:04:44Z","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":17652,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-16T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.1,"usd":0.01,"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-senior-auditor-quality-opsp"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"free","price":{"credits":0,"usd":0},"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-senior-auditor-quality-opsp"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.1,"usd":0.01},"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-senior-auditor-quality-opsp"},{"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-senior-auditor-quality-opsp\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcotiviti-senior-auditor-quality-opsp"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":3723602}},{"tool":"search_jobs","arguments":{"company":"cotiviti.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":3723602},"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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