Clinical Auditor

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our mission is simple: to bend the cost curve in healthcare for all.

Our commitment to service excellence extends to both internal and external stakeholders, driving us to consistently exceed expectations. We operate with intention and purpose-fostering innovation, championing diversity, nurturing accountability, and empowering each other to reach our collective potential.

Join us as we continue our transformational journey to become a leading voice in healthcare technology, data, and innovation.

The Clinical Auditor analyzes high-dollar and complex healthcare claims to ensure accurate billing practices and regulatory compliance.

In this role, you will apply advanced clinical knowledge, coding standards, industry expertise, and federal regulations to review itemized hospital bills and claim documentation. You will identify billing abnormalities, unbundling, questionable billing practices, and improper coding combinations while clearly documenting audit findings and denial rationale.

• 
  

  Review and analyze complex inpatient and outpatient claims across multiple revenue centers, considering diagnosis, procedures, patient demographics, and facility type

  
  
• 
  

  Perform detailed itemized bill reviews to identify unbundling, duplicate charges, and billing irregularities

  
  
• 
  

  Apply national coding standards, payer policies, and federal/state regulations to claims review

  
  
• 
  

  Document audit findings, denial rationale, and system updates with accuracy and clarity

  
  
• 
  

  Research claims, trends, operative notes, and supporting documentation to support audit decisions

  
  
• 
  

  Identify opportunities for cost recovery and overpayment prevention; present findings to leadership

  
  
• 
  

  Monitor coding trends, regulatory updates, and industry practices impacting claim accuracy

  
  
• 
  

  Apply clinical judgment and analytical expertise to review highly complex or escalated cases

  
  
• 
  

  Communicate audit findings and reimbursement insights clearly to internal stakeholders and leadership

  
  
• 
  

  Serve as a subject matter expert (SME) and resource to clinical and operational teams

  
  
• 
  

  Collaborate cross-functionally to support departmental goals and process improvements

  
  
• 
  

  Monitor turnaround times and recommend workflow efficiencies

  
  
• 
  

  Support development of educational materials, job aids, and training resources

  
  
• 
  

  Ensure compliance with HIPAA and all applicable regulatory requirements

  
  
• 
  

  Demonstrate company core competencies and contribute to a culture of accountability and excellence

  
  

This role operates with a high level of independence, managing multiple complex audits simultaneously in a fast-paced environment. Work is varied and analytical in nature, requiring strong decision-making skills and the ability to interpret nuanced clinical and coding scenarios.

The salary range for this position is $75-80k annually. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401(k) and bonus opportunity.