Senior Auditor Appeals - OPSP

The Senior Auditor, Appeals position is part of the Clinical Chart Validation (CCV) team and is responsible for defending Cotiviti’s recovery determinations utilizing the appropriate guidelines including but not limited to Commercial, CMS inpatient and outpatient coding guidelines, coding clinics, and internal clinical validation policies if applicable. The appeals auditor is responsible for performing an extensive review of the initial claim along with the associated documentation as well as any additional information submitted by the provider on appeal. The appeals auditor will render a decision, and formulate a written response, on each claim reviewed providing the most accurate decision