Medical Review Auditor Job Description: Fraud, Waste & Abuse

The remote Medical Reviewer position at Cotiviti targets healthcare fraud, waste, and abuse by auditing medical records and claims. Offering an annual base compensation ranging from $70,000 to $91,000, the work-at-home role requires a credential such as a Certified Professional Coder (CPC, CCS, or CCS-P) to evaluate medical coding accuracy against federal, state, and payer policies.

Cotiviti’s recruitment window highlights the demand for administrative oversight within health infrastructures. Managing healthcare compliance requires balancing strict adherence to established coding conventions with a deep understanding of reimbursement methodologies.

The core responsibility of a Fraud, Waste, and Abuse Medical Reviewer involves auditing medical records to assess the precision of medical coding. Reviewers evaluate whether healthcare claims comply with established policies, procedures, and federal regulations. This process requires familiarity with major medical coding systems, including the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classifications (APCs), Diagnosis-Related Groups (DRGs), and Revenue Codes, alongside Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) guidelines.

By conducting detailed medical policy research, reviewers identify suspicious patterns in documentation and areas of vulnerability. When deficiencies emerge, professionals prepare reports detailing findings and recommending corrective practice changes or process improvements. This evaluation safeguards the financial sustainability of health plans while upholding regulatory standards.

In Plain English: The Clinical Takeaway

• What Reviewers Do: These professionals audit medical records to evaluate the accuracy of medical coding and health plan policies.
• Why It Matters: Identifying suspicious patterns in medical record documentation and ensuring compliance with policies, procedures, and regulations supports Fraud, Waste & Abuse efforts.
• The Skill Set Required: The job demands a required credential—a Certified Professional Coder (CPC, CCS, or CCS-P)—paired with knowledge of medical billing codes like ICD and CPT.

Compensation, Qualifications, and Remote Work Framework

The remote position, which has an anticipated application window closing on 8/17/2026, offers a base salary range between $70,000 and $91,000 per year, determined by qualifications, certifications, and experience. Eligible candidates must possess either a Bachelor’s Degree in a related discipline or an equivalent combination of professional training and work experience. Preferred professional licenses include a Licensed Practical Nurse (LPN) or a Registered Nurse (RN), alongside a mandatory credential such as a Certified Professional Coder (CPC, CCS, or CCS-P) supported by two to five years of related experience in auditing medical records.

Cotiviti structures the role as a work-at-home position restricted to candidates based in the United States who can maintain a dedicated, secure home workspace with high-speed internet access. The compensation package includes benefits such as medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, nine paid holidays, and between 17 and 27 days of Paid Time Off (PTO) annually, depending on service length and organizational level.

Cotiviti Medical Reviewer Position Overview

Parameter	Details
Position Focus	Fraud, Waste, and Abuse (FWA) Medical Review
Work Arrangement	Remote (Work-at-home, US only)
Base Compensation Range	$70,000 to $91,000 per year
Required Credentials	CPC, CCS, or CCS-P (RN or LPN preferred)
Experience Required	2–5 years of medical records auditing

Work Environment

Professionals in this role should note that this desk-bound, remote role involves remaining in a stationary position, often standing or sitting for prolonged periods, and repeating motions that may include the wrists, hands, and/or fingers. The role requires the ability to positively handle/manage stress, such as high work volume and frequent change.

Future Outlook for Healthcare Compliance Oversight

As health records continue to be utilized across payer networks, the demand for auditing mechanisms remains. Professionals equipped with coding expertise play a role in maintaining transparency and accountability within the healthcare economy.