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Role Description

Perform Dental daily review/audits on client data for completeness and accuracy of coding, utilizing coding background to ensure appropriateness for reimbursement when providing recommendations on clinical claims to the client.

• Makes certain the requirements for Current Dental Terminology (CDT), ADA and other related concessions are met.
• Performs duties according to structured algorithms or other written guidelines.
• Handles moderately complex issues, refers all medical necessity procedures to higher-level staff for approval or denial.
• Possesses solid working knowledge of subject matter.
• Reports to a department head or manager.

Responsibilities

• Perform daily audits on client data for completeness and accuracy of coding utilizing coding background to ensure appropriateness for reimbursement.
• Provide recommendations on clinical claims to the client without interpreting or evaluating clinical information.
• Respond to provider appeals of non-clinical issues.
• Respond to client logics and record reviews of non-clinical issues.
• Assess and respond to client/provider educational needs.
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
• Contribute to the team by providing feedback to the Management and Development team on changes to enhance editing and efficiency.
• Participate on the Quality Committee as required.
• Complete all responsibilities as outlined on annual Performance Plan.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

• High School Diploma, GED or equivalent work experience.
• Dental coding certificate preferred - Have this credential or ability to sit for it.
• Minimum of 3 years work experience in a clinical role in the dental office, as a Dental Assistant or Dental Hygienist.
• General knowledge of dental procedures, conditions, and treatment practices.
• Excellent written and verbal communication skills.
• Ability to think logically and process sequentially with a high level of detailed accuracy.
• Excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
• Ability to conduct training to both internal staff and clients in an efficient and effective manner.

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 are expected.

Compensation and Benefits

• Base compensation ranges from $20.00 to $25.00 per hour.
• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week.
• Cotiviti offers a competitive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans, paid family leave, 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

Application Information

Date of posting: 3/2/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 4/30/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.