Auditor Technical Trainer - POS

About the role

This role is part of the training team for the Clinical Chart Validation team. The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.

Responsibilities

• Training, Development, and Mentoring.

  • Assess job-specific needs and develop technical training plans with clear business objectives, including working with subject matter experts, developing training materials, and developing appropriate assessments and measurements of success.
  • Select training/instructional methods and procedures appropriate for the situation when learning or teaching new skills.
  • Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar.
  • Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills.
  • Provide support to the CCV audit team members; assist with orientation of new members as needed, mentor new team members after orientation.
  • Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings.
  • Encourage critical thinking and discussion among team members on concepts as needed.
  • Provide training on one or more of the following audit types:

• Conduct or arrange for ongoing technical training and personal development classes for staff members.

• Quality Assurance Controls.

  • Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews.
  • Draw on healthcare proficiency and industry knowledge to substantiate conclusions.
  • Perform work independently, review and interpret audit work of others.
  • Depending on the nature and scope of the 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.
  • Demonstrate an understanding of complex contract specifications when performing medical record reviews.
  • Use healthcare expertise to determine approval or referral to the Medical Director.
  • Provide feedback on reviews to the Quality Assurance Manager as indicated in order to assist with the improvement of rationales sent to providers.

• New Concepts and Processes.

  • Develop reasonable and effective recommendations for concept solutions that reflect an understanding of the client environment and risks inherent to our business and industry.
  • Suggest and or develop and implement new ideas, approaches, decision trees, and/or technological improvements that will support and optimize audit results.
  • Collaborate with Data Services in developing new reports.

• Mets or Exceeds Standards/Guidelines for Productivity.

  • In addition to regular and predictable attendance, maintain production goals and quality standards set by the audit.
  • Performs QA audits against the expected level of quality and quantity (i.e. hit rate, # claims written, ID per hour).

Qualifications

• Education/Certification/Licenses (required):

  • Associate or Bachelor's degree in nursing.
  • RN License (active /unrestricted in state of residence).
  • Case Management Certification (preferred, but not required).
  • Additional certifications in Interqual or MCG (preferred, but not required).

• Experience:

  • 5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation).
  • Background in Utilization Management and/or Case Management.
  • Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg.
  • 5 to 7+ years of working with a broad knowledge of medical claims, billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
  • Adherence to official coding guidelines and other regulatory compliance guidelines and mandates.
  • Requires expert level knowledge of Interqual and/or MCG criteria.
  • Strong presentation skills.
  • Comfortable in presenting/defending audit logic to clients and key stakeholders (i.e. hospitals, physicians, validation contractors, auditing team, etc.).
  • Independent thinker, logical, strategic, with a high focus and attention to detail.
  • Effective communication and presentation style (written and verbal) with proven ability to positively influence behavior and outcomes.
  • Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
  • Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines.
  • Professional demeanor: Ability to creatively solve problems, deal with ambiguity, develop and implement policy and procedures, perform analysis and prepare reports, and foster team building.
  • High level of proficiency with all audit technology i.e., R3, CAT, etc.
  • Proficiency in Word, Access, Excel, PowerPoint and other applications.
  • Excellent written and verbal communication skills.
  • Applicants should have home health, IRF, and SNF experience.

• Mental Requirements:

  • Communicating with others to exchange information.
  • Problem-solving and thinking critically.
  • Completing tasks independently.

• 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.

Pay

Base compensation ranges from $105,000 to $125,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Schedule

Not specified.

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

TBD