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Senior Clinical Validation Appeal/QA Auditor Remote (anywhere US)
Job ID R27258
Date posted 05/23/2022
Senior Clinical Validation Appeal/QA Auditor
Overview of Position
The Senior Clinical Validation (CVA) Appeal/QA Auditor is responsible for the review and response to provider second level Clinical Validation Audit appeals. The Senior Clinical Validation Appeal/QA Auditor provides feedback regarding the outcome of these reviews to the Clinical Validation Auditors. This position is responsible for responding to and coordinating facility peer-to-peer reviews.
What will be my duties and responsibilities in this job?
Performs second level rebuttal/appeal reviews, responds to the provider, and provides feedback to the CVA Auditors.
Suggests potential training opportunities as well as input on potential new audit concepts or screening rules.
Coordinates peer-to-peer facility and second level appeal requests with physician reviewer and presents content on peer-to-peer review meetings.
Responsible for appeal inventory management to ensure claims are processed within specific timeframes.
Respond to CVA team questions and referrals for QA review.
Demonstrates ability to appropriately apply clinical criteria to a variety of claims scenarios and effectively utilize audit tools.
Demonstrates ability to research criteria and evaluate it for accuracy.
Works independently to meet or exceed productivity and accuracy goals.
Communicates audit findings with excellent grammar and writing skills.
Maintains current knowledge of clinical guidelines, reimbursement trends, and client expectations.
Demonstrates commitment to Change Healthcare core values.
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
What are the requirements needed for this position?
An active and unrestricted RN license
3 years of clinical nursing experience in the inpatient setting
3 years of inpatient coding experience including documented competency in ICD-10; or 3 years of inpatient CDI experience; or equivalent experience
What critical skills are needed for you to consider someone for this position?
Ability to perform in-depth analysis of clinical documentation relating to diagnoses
Must have experience with clinical validation auditing
Proficiency with MS Office along with good ability to learn new systems
Excellent spoken and written communication skills
Excellent analytical skills
High level organizational and prioritization skills with the ability to manage multiple, concurrent projects and tasks effectively
What other skills/experience would be helpful to have?
Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) a plus
Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) a plus
Degree from accredited college or university a plus
What are the working conditions and physical requirements of this job?
General office demands/Home office
How much should I expect to travel?
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COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
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Talent Acquisition Process
Once you apply for a job opening, the Sourcing Specialist or Talent Advisor will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.
Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.
If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.
Once you've electronically signed your offer, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.
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