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Senior Clinical Validation Appeal/QA Auditor Remote (anywhere US)

Change Healthcare
United States, Oregon, Portland
June 26, 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?

  • No travel

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

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.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.comwith "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formatted ESQA 508c.pdfto view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

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