• The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. • Confirms correct CPT coding assignments. • Analyzes, enters and manipulates the claim in the respective database. • Responds to or clarifies internal requests for medical information. • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. • Follows established guidelines/procedures. • Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines. • Utilize encoders and various coding resources. • Perform CPT Procedure reviews. • Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information. • Maintain current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols.

• Responsible for coordinating and completing the three phases of a risk review: Planning, Fieldwork, and Reporting. • Conduct walkthroughs, interact with line of business personnel, test and document internal controls, ensuring compliance with laws and regulations, draft findings and reports, and identify risks and controls across business functions. • Lead complex reviews, manage staff, provide feedback, and participate in ad-hoc projects, risk intelligence activities, and training.

• Serve as an independent member of the Board of Directors, participating in deliberations with autonomy, critical judgment and fiduciary responsibility; • Fulfill the duties of care and loyalty, ensuring decisions are well-founded, impartial and aligned with the institution’s best interests; • Contribute to defining and reviewing strategic guidelines, assessing alignment between the organization’s mission, operational capacity and financial sustainability; • Evaluate senior management performance, monitoring targets, KPIs and adherence to Board-approved directives; • Review financial statements, management reports and institutional disclosures, ensuring consistency, compliance and information quality; • Assess risk management policies and practices, including risk appetite definition and the effectiveness of mitigation measures; • Oversee the effectiveness of internal controls, compliance programs and institutional integrity; • Chair the Audit Committee, ensuring meetings are managed, deliberations are documented and qualified reporting is provided to the Board; • Oversee internal and external audits, including assessments of independence, scope, findings and remediation plans; • Monitor the whistleblower channel and investigation processes, ensuring integrity, confidentiality and appropriate handling; • Review sensitive transactions, including related-party transactions, from a governance and conflict-of-interest prevention perspective; • Support the Board with external market perspective, benchmarking and relevant experience that inform strategic decisions; • Prepare and present technical reports to the Board, including assessments of the control environment and the organization’s integrity.

Overview The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Quality assurance emphasizes compliance with established procedures, accuracy of claim identification and supportive documentation. Identifies and notifies management of observed quality and communicates opportunities for process improvements based on independent audit claims review. Displays professional skepticism that enhances the work performed in order to achieve success in position. Responsibilities - Performs clinical quality assurance review of daily clinical validation reviews. The quality auditor will be responsible for communicating with the initial auditor when there are differing decisions on the audit to ensure that the final decision is supported and as accurate as possible. - Integrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review. - Utilizes industry knowledge and proficiency in healthcare to substantiate decisions. - Performs work independently and reviews work of others. - Depending on nature and scope of audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns. - May serve as a mentor to other QA auditors or initial auditors. - Depending on the business needs, may also flex into the initial audit role and/or the appeals role as needed. 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 requirements of the job change. Qualifications - Education (at least one of the following are required)- - Associates or Bachelor's degree in Nursing (active / unrestricted license). - Associates or Bachelor's degree Health Information Management (RHIA or RHIT). - 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 Certification (at least one of the following are required and are to be maintained as a condition of employment). - RHIA or RHIT - Inpatient Coding Credential - CCS or CIC preferred. - Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company. - 3-5 years of healthcare auditing or related experience. - Ability to mentor staff and enhance performance as it relates to the quality and productivity of auditors. - Excellent verbal and written communication skills. - Ability to work well in an individual and team environment. - Computer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint,etc.). 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. Base compensation ranges from $47.00 to $56.00 Hr. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 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: 2/9/2026 Applications are assessed on a rolling basis. We anticipate that the application window will close on 4/9/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.