Clinical Consultant I
Read straight from Cotiviti's careers page, verified 1d ago.Seekless can tailor your résumé to it.
Seekless can write your résumé for this posting first.
Before you apply
Salary$80k – $95k
LocationRemote, UNAVAILABLE, US
Work moderemote · United States
Typefull-time
SeniorityMid
Experience2+ yrs
DepartmentClient Services
Company size1,001–5,000 people
PostedAug 23, 2026 · 2mo ago
Verified live1d ago
At a glanceSummarised by Seekless from the posting.
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
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
Ability 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, PowerPoint)
Demonstrates basic working knowledge of Nucleus, JIRA, Mantis, MicroStrategy, Tableau within 90 days of hire
Knowledge of medical terminology
Detail oriented
Ability to handle multiple tasks, prioritize and meet deadlines
Effective analytic and problem-solving skills
Professional with ability to properly handle confidential information
Ability to work well independently and a track record of successful outcomes within a collaborative team environment
Ability to work in a fast-paced environment, effectively organize, prioritize and meet deadlines
Strong written and verbal communication and interpersonal skills
Ability to work with remote cross-functional product teams
Computer and technology literate
Must have ability to positively handle/manage stress, such as high work volume and frequent change
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
Travel requirement up to 10%
Working knowledge of Cotiviti systems preferred
After hours and/or weekend work may be required where necessary for major deliverables/deadlines (not consistent)
This remote role can be located anywhere in the continental US
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
Must be able to sit and use a computer keyboard for extended periods of time
Skills
Microsoft Office Suite
Word
Excel
PowerPoint
Nucleus
JIRA
Mantis
MicroStrategy
Tableau
Benefits
Medical
Dental
Vision
Disability
Life insurance
401(k)
Paid family leave
9 paid holidays
17 27 days PTO
Overview
The Clinical Consultant support Clinical Services teams in the validation of quality and processes consistency on the CPE editing engine.
Provides support and subject matter expertise on Coding Validation (CV) to both clients and internal stakeholders during the planning, implementation, go-live, transition to operational team, and through the duration of the contract. Clearly understands and articulates CV concepts and policies. Collaborates with internal teams to provide meaningful input on CV processes, improvements, and support to maximize value and service for clients. Supports internal teams with preparation of new policy presentations and appeals management process. Supports validation of quality and process consistency including customization requests, payment policies, pre and post testing, and UAT testing.
Responsibilities
Client facing Coding Validation support:
•
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.
•
Provide action plans to mitigate future issues as needed with Quality Team in close internal collaboration.
Add Value to Internal Teams:
•
Proactively offer benefit of CV knowledge and experience.
•
Work collaboratively with Client Teams to develop and maintain excellent client relationships.
•
Collaborate and provide input from a client-based perspective on changes in edit configuration, updates to existing rules, and development of new editing.
•
Assist the Clinical Content Team with feedback from a client perspective on new trends and application of new rules.
•
Work with Quality, Training, and Operations Teams as needed to facilitate any updates in CV review guidelines, effectively communicate changes in client specific review, and address other CV client issues in an accurate and timely manner.
•
Support resource for the Clinical Services team on Coding Validation implementations, including reviewing test claims, and internal go-live support.
•
Act as a support liaison for appeals management process.
Quality:
•
Support CPE Clinical Services quality assurance processes including pre and post release testing and other areas of need as identified.
•
Assist the Clinical Content Teams with validation and review of client payment policies.
•
Maintain Client Information Workbooks with updated information as needed to maintain accuracy in CV review.
•
Provide support during user acceptance testing in Nucleus.
Legal
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 (required)
•
Associate or Bachelor’s degree in Nursing (active/unrestricted license).
License & Certification-
•
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.
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.
Skills and Other Requirements:
•
Ability 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).
•
Working knowledge of Cotiviti systems preferred.
•
Demonstrates basic working knowledge of the following applications within 90 days of hire:
•
Nucleus, JIRA, Mantis, MicroStrategy, Tableau.
•
Knowledge of medical terminology.
•
Detail oriented.
•
Ability to handle multiple tasks, prioritize and meet deadlines.
•
Effective analytic and problem-solving skills.
•
Professional with ability to properly handle confidential information.
•
Ability to work well independently and a track record of successful outcomes within a collaborative team environment.
•
Ability to work in a fast-paced environment, effectively organize, prioritize and meet deadlines.
•
Strong written and verbal communication and interpersonal skills.
•
Ability to work with remote cross-functional product teams.
•
Computer and technology literate.
•
Must have ability to positively handle/manage stress, such as high work volume and frequent change.
•
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
•
After hours and/or weekend work may be required where necessary for major deliverables/deadlines (not consistent).
•
Travel requirement up to 10%.
Cognitive / Mental Requirements:
•
Ability to analyze complex data and synthesize it for customer and internal consumption.
•
Detail oriented.
•
Effective analytic and problem-solving skills.
•
Professional with ability to properly handle confidential information.
•
Ability to work well independently and a track record of successful outcomes within a collaborative team environment.
•
Ability to work in a fast-paced environment, effectively organize, handle multiple tasks, prioritize and meet deadlines.
•
Ability to work with remote cross-functional product teams.
•
Must have ability to positively handle/manage stress, such as high work volume and frequent change.
Physical Requirements and Working Conditions:
•
This remote role can be located anywhere in the continental US.
•
Repeating motions that may include the wrists, hands, and/or fingers.
•
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
•
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.
•
Must be able to sit and use a computer keyboard for extended periods of time.
•
No adverse environmental conditions expected.
Base compensation ranges from $77,000 to $94,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Benefits
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: 8/21/2026; REPOSTED 11/2/2026
Hiring process
Applications are assessed on a rolling basis. We anticipate that the application window will close on 1/2/2027, 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-JB1#senior