Hiring: Clinical Consultant I Company: Cotiviti Location: United States Job Posted Time: 2026-09-14 13:44:37 Employment Type: Contract / Remote Target Skills & Keywords : CV, Jira, Microsoft Excel, Microsoft Office, Quality Assurance, Regulatory Compliance, Utilization Review About the job Experience: •2+ years of clinical experience as a Registered Nurse. •1+ years of experience in Coding Validation. •1+ years of experience in coding including professional and outpatient facilities. •1+ years of experience in claims adjudication, medical/payment policy, or utilization review working for a managed care or healthcare insurance company, or related experience. •1+ years of experience in customer service or client management with a strong focus on healthcare setting. Required Skills: •Act as a liaison for clinical information between internal partners and external customers. •Provide resources to facilitate client understanding of Coding Validation policies and concepts. •Respond to client inquiries in a timely manner in compliance with policy and procedures. •Review and analyze CV related client inquiries and Change Requests for clarity of intent, assessing impact of decisions for affected policies, and communicating effectively with the client to address questions or clarify information. •Provide support and resources to clients for provider abrasion issues. •Review and provide written and/or verbal explanation of CV coding concepts. •Resource to client for CV related quality issues. •Appropriately and effectively communicate quality review results and revisions (if applicable) to clients when they occur. Qualifications: •Associate or Bachelor’s degree in Nursing (active/unrestricted license). •Registered Nursing license (RN) – active and unrestricted in state of residence. •Professional coder certification (CPC, CPC-H, CPC-P, or CCS-P), RHIT or RHIA certification required. •Demonstrated capacity to analyze complex data and synthesize it for customer and internal consumption. •Strong research capabilities and knowledge of CMS guidelines and other regulatory compliance guidelines and mandates, and medical payment policy. •Proficient with Microsoft Office Suite (Word, Excel, Power Point). •Solid functional working knowledge of Cotiviti systems preferred. •Nucleus, JIRA, Mantis, MicroStrategy, Tableau. •Ability t o handle multiple tasks, prioritize and meet deadlines. •Effective analytic and problem-solving skills. Compensation: •$80,000 - $95,000 / year •Flexible work environment (work from home / hybrid options) •Competitive benefits and rewards package Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!