Coding Validation Coder I

Overview

Cotiviti has multiple openings for full-time coders....these roles will focus on claims audits for appeals, checking for completeness & accuracy based on coding guidelines. Experience with E&M coding & auditing is preferred. These are full-time remote positions and can be done anywhere within the continental US and will work a traditional day time schedule.

Responsibilities

• Clinical Validation - Perform daily audits on provider appeals for completeness and accuracy based on specified coding guidelines to ensure appropriateness for reimbursement.
• Apply client specific coding guidelines when applicable.
• Learns new appeal categories as production need requires.
• Stays current on coding guidelines appropriate to the position.
• Uses the Cotiviti applications to processes CV appeals to meet both production and accuracy standards.
• Reviews quality feedback from QA.
• Submits questions for clarification as needed.
• Utilizes the ‘QA Resolution’ process when disagreement occurs related to a CV Appeals determination.
• Regular interaction with other Cotiviti staff, such as training and quality assurance to facilitate clarification and/or training on coding results.
• Professionally communicates finds, errors, and any suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process.
• Utilize Cotiviti training tools and CV library for questions.
• Provide teaching, mentoring and or oversight on appeal categories when requested.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This 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.

Qualifications

Education (required):

• High School Diploma or GED required.
• Nationally certified medical coder as certified by either AAPC or AHIMA. (CPC, CCS, etc.)

Experience (required):

• At least 1-2 years of medical coding experience.
• Experience in CPC coding required.
• Adherence to official coding guidelines, coding clinic determinations, CMS, Client specific guidelines and other regulatory compliance guidelines and mandates.
• Excellent written and verbal skills to include interpersonal skills.
• Strong knowledge of medical terminology and anatomy and physiology.
• Skills in organization and time management.
• Ability to read and understand medical record documentation for diagnosis extraction.
• Computer and technology literate.
• Must be able to work in a fast-paced environment.
• Ability to manage and meet deadlines.
• Must remain flexible to provide assistance in any emergent situations and/or projects.
• Must participate in any required training.
• Must abide by all HIPAA and associated patient confidentiality requirements.

Mental Requirements:

• Ability to absorb new information quickly and train in a fast-paced environment and ability to learn, test and pass off new training concepts daily.
• Ability to work in a high-pressure production environment and make audit decisions efficiently and accurately.
• Possesses excellent written and verbal communication skills.
• Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
• Assessing the accuracy, neatness and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• No adverse environmental conditions expected.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.

Base compensation ranges from $24.00 to $27.00 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.

Non-Exempt 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.

Cotiviti 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 at Healthcare Analytics Careers | Cotiviti.

Date of posting: 8/7/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/11/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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