Clinical Review Auditor

Clinical Review Auditor at Cor Vel Corporation

This is a remote position.

• The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and review of supporting clinical documentation.
• Conduct audits to ensure accurate reimbursement and identifying potential savings.
• Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid.
• Understand and comply with all internal and external policies.
• Working knowledge of HIPAA Privacy and Security Rules.
• Assist Quality Control team and medical director with appeals, rebuttals, etc.
• Notify leadership of any issues or concerns in a timely manner.
• Additional duties as assigned.

• Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines.
• Effective and professional communication skills, both verbal and written.
• Ability to work independently and in a team environment.
• High attention to detail.
• Must possess critical thinking skills.
• Ability to multi-task and assist with team coverage and provide support when needed.
• Ability to build relationships both internally and externally.
• Ability to work in a fast-paced environment.
• Demonstrated proficiency in basic computer skills and typing.
• Proficiency with Microsoft Office.

• LVN or RN license in the state of employment preferred.
• CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS.
• Experience in the OR, ICU, or ER as an RN highly preferred.

Cor Vel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $68,566 – $104,841

CERIS, a division of Cor Vel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities.

We embrace our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre‑paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

Cor Vel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable.