Top 955 Clinical quality assurance Jobs in Remote

Auditor Clinical Validation DRG
Cotiviti —Remote
- $45.67 an hour
- Full-time
- Nursing
- 5 years
- Writing skills
- Paid holidays
- Disability insurance
11d
Medical Accuracy Reviewer
LiveWorld Inc —Remote
- $20 - $22 an hour
- Part-time
- Remote
- 18 years or older
- Computer literacy
- Salesforce
- Work from home
Quick Apply
Medical Quality Assurance Lead (QAL)
SME Careers by SuperAnnotate —Remote
- Contract
- Remote
- Medicine
- Management
- English
Psychology Quality Assurance Lead (QAL)
SME Careers by SuperAnnotate —Remote
- Contract
- Remote
- Management
- Psychiatry
- English
Associate Director, Clinical Quality Compliance
Biogen —Remote
- $148,000 - $204,000 a year
- Full-time
- Master's degree
- Analysis skills
- Bachelor's degree
- Paid parental leave
- Employee stock purchase plan
3d
Clinical Quality Assurance Coordinator
MES Solutions —Norwood, MA
- $27 - $29 an hour
- Full-time
- Remote
- Nursing
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Document Control & Quality Systems Administrator
Noctrix Health —Remote
- $120,000 - $140,000 a year
- Full-time
- Remote
- 3 years
- Continuous improvement
- Neurology
Quick Apply
Specialist, Quality Assurance
Care Access —Boston, MA
- $70,000 - $90,000 a year
- Remote
- Microsoft Word
- Pass drug screening
- Mid-level
- Health savings account
- Paid holidays
11d
Clinical Quality Assurance Coordinator
ExamWorks —Rockford, IL
- $28.50 an hour
- Full-time
- Remote
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Clinical Operations Coordinator
Trusted Ally Home Care —Remote
- $85,000 - $95,000 a year
- Full-time
- Remote
- RN License
- Mid-level
- Home Health
- Health insurance
- Dental insurance
Quick Apply
5d
Sr. Clinical Customer Advocate
Dexcom —Remote
- $95,900 - $159,900 a year
- Full-time
- Remote
- Nursing
- RN License
- Bachelor's degree
1d
Clinical Documentation Specialist (CDI)
Solventum —Remote
- $96,000 - $132,000 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Health savings account
- Disability insurance
Public Health Analyst II
Goldbelt, Inc. —Remote
- $90,000 - $105,000 a year
- Full-time
- Nursing
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Manager, Quality Assurance
Clario —Remote
- Full-time
- Remote
- 7 years
- HIPAA
- Business development
- Health insurance
- Dental insurance
Biomedical Engineering Quality Assurance Lead (QAL)
SME Careers by SuperAnnotate —Remote
- Contract
- Remote
- Management
- English
- Mid-level
Patient Access Representative
Clinical Health Network —Remote
- $17.00 - $25.50 an hour
- Weekends as needed
- Remote
- Medical office experience
- HIPAA
- No high school diploma
- Health savings account
- AD&D insurance
Senior Manager Quality Audit Operations (Clinical Chart Validation)
Cotiviti —Remote
- $120,000 - $160,000 a year
- Full-time
- Computer Science
- HIPAA
- 3 years
- Paid holidays
- Disability insurance
Neuroscience Quality Assurance Lead (QAL)
SME Careers by SuperAnnotate —Remote
- Contract
- Remote
- Management
- Laboratory experience
- English
Senior Clinical Quality Performance Specialist
Amerihealth Caritas —Manchester, NH
- Full-time
- Remote
- Nursing
- RN License
- 5 years
Nurse Educator & Quality Assurance Specialist (Contractor)
Everlywell —Remote
- Contract
- Remote
- Google Workspace
- RN License
- 5 years

I want to receive the latest job alert for clinical quality assurance in remote

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

clinical quality assurance jobs near remote

Senior Quality Specialist jobs in Manchester, NH

Senior Customer Advocate jobs in Remote

Quality Assurance Manager jobs in Remote

Systems Administrator jobs in Remote

Quality Assurance Coordinator jobs in Rockford, IL

Public Health Analyst jobs in Remote

Clinical Documentation Specialist jobs in Remote

Quality Assurance Analyst jobs in Boston, MA

Director Of Compliance jobs in Remote

Clinic Operations Manager jobs in Remote

Auditor jobs in Remote

Patient Access Representative jobs in Remote

Senior Quality Specialist jobs in Elgin, IL

Child Life Specialist jobs in St. Louis, MO

Quality Assurance Specialist jobs in Minnesota

Senior Quality Specialist jobs in Glendale, CA

Quality Assurance jobs in Grand Rapids, MI

Reading Specialist jobs in Massachusetts

Senior Quality Specialist jobs in Pomona, CA

Senior Quality Specialist jobs in Minneapolis, MN

Auditor Clinical Validation DRG

Cotiviti -
Remote

Apply Now

Job Details

Full-time
$45.67 an hour
11 days ago

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Family leave
Vision insurance
Life insurance

Qualifications

Writing skills
CMS
Regulatory compliance
Centers for Medicare & Medicaid Services (CMS) billing regulations
Productivity software
Clinical documentation standards
Medical terminology
DRG

Full Job Description

Overview:

This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.

Responsibilities:

Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.
Effectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team.
Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim.
identification and documentation (letter writing).
Identifies New Claim Types.
Identifies potential claims outside of the concept where additional recoveries may be available.
Suggests and develops high quality, high value concept and or process improvement, tools, etc.
Complete all responsibilities as outlined on annual Performance Plan.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.
Complete all responsibilities as outlined on annual Performance Plan.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

Qualifications:

Education (at least one of the following are required):

Associate or bachelor’s degree in nursing (active /unrestricted license).
Associate or bachelor’s degree Health Information Management (RHIA or RHIT).
High school diploma or GED plus equivalent experience of 5+ years’ experience in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment.

Coding/CDI Certification (at least one of the following are required and are to be maintained as a condition of employment):

RHIA or RHIT.
CPC.
Inpatient Coding Credential – CCS, CIC, CDIP or CCDS.

Experience (required):

5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APRDRG, ICD-10, CPT, HCPCS codes.
Requires working knowledge of and applicable industry-based standards.
Proficiency in Word, Access, Excel, TEAMS, and other applications.
Excellent written and verbal communication skills.

Mental Requirements:

Communicating with others to exchange information.
Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

Remaining in a stationary position, often standing or sitting for prolonged periods.
Repeating motions that may include the wrists, hands, and/or fingers.
Must be able to provide a dedicated, secure work area.
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
No adverse environmental conditions expected.

Base compensation is paid hourly at $45.67 per hour (95k annualized). This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 8/24/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/31/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-Remote

#LI-JJ1

#senior

Apply Now

Refine Your Search

clinical quality assurance jobs in remote

Auditor Clinical Validation DRG

Medical Accuracy Reviewer

Medical Quality Assurance Lead (QAL)

Psychology Quality Assurance Lead (QAL)

Associate Director, Clinical Quality Compliance

Clinical Quality Assurance Coordinator

Document Control & Quality Systems Administrator

Specialist, Quality Assurance

Clinical Quality Assurance Coordinator

Clinical Operations Coordinator

Sr. Clinical Customer Advocate

Clinical Documentation Specialist (CDI)

Public Health Analyst II

Manager, Quality Assurance

Biomedical Engineering Quality Assurance Lead (QAL)

Patient Access Representative

Senior Manager Quality Audit Operations (Clinical Chart Validation)

Neuroscience Quality Assurance Lead (QAL)

Senior Clinical Quality Performance Specialist

Nurse Educator & Quality Assurance Specialist (Contractor)

I want to receive the latest job alert for clinical quality assurance in remote

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected