Team Lead Senior Auditor CCV (Place of Service, Short-Stay, Readmission)

About the role

This is a Senior Auditor, Team Lead position responsible for supervising a team of Clinical Validation Auditors or other audit team members. Team Leaders ensure that the work of others meets productivity standards, quality guidelines, and audit efforts of the client engagement. The goal is to ensure the team audits client data on behalf of clients, generating high-quality recoverable claims while displaying professional skepticism.

Responsibilities

• Oversees audit team responsible for producing quality audit outcomes and well-written sustainable findings.
• Provides support to the audit team to ensure outcomes are based on nationally recognized standards and proprietary clinical validation guidelines.
• Monitors the flow of claims ensuring adherence to client SLAs.
• Optimizes team and individual auditor performance, including production, accuracy, and quality deliverables.
• Handles training and process improvements in conjunction with the team; works with Quality Assurance to ensure auditors meet accuracy and quality execution of audit deliverables.
• Develops and implements remediation efforts when warranted.
• Manages employee reviews, new hire onboarding, PTO, coaching, and mentoring; monitors staff productivity.
• Serves as the first-level resource for Clinical Validation auditors regarding specific claims and clinical industry standards.
• Creates an environment that fosters information sharing.
• Collaborates with Manager and Human Resources in applying best practices to areas of Employee Relations and performance management.
• Ensures all Cotiviti and department rules and processes are followed.
• Assists and coordinates with the manager to hire and retain top talent.
• Actively recommends system or process improvements or enhancements to increase productivity, quality, or cost containment.
• Captures system issues for IT escalation, tracks, and reports downtime.
• Ensures operational controls and day-to-day processes are in place to meet client budget goals.
• Strategically distributes work among auditors to ensure timely completion and optimized results.
• Uses data and analytic techniques to monitor client performance, identify, and remediate outliers.
• Provides metrics and information, as requested or scheduled, including hours worked, members reviewed, calls made, claims written, and dollars found.
• Elevates provider/client suggestions and concerns to the appropriate Audit Manager and offers solutions as needed.
• Ensures alignment between strategic goal-setting and performance management processes to achieve organizational goals.
• Hires, develops, coaches, leads, and retains top-tier talent, focusing on building and improving a team culture that drives high levels of internal and external customer satisfaction.
• Completes all responsibilities outlined in the annual performance review and/or goal setting.
• Completes all special projects and other duties as assigned.

Requirements

• Associate or Bachelor’s degree in nursing.
• Active/unrestricted RN License in the state of residence.
• Case Management Certification (preferred).
• Coding or Clinical Documentation Certification (preferred).
• 2+ years’ prior management or supervisory experience preferred.
• 5+ years of related experience in auditing, quality, or appeals focused on Place of Service, Short Stay, and Readmission audits.
• Computer proficiency in Microsoft Excel, Access, and system databases.
• Prior healthcare billing and/or claims experience desired but not required.
• Ability to mentor staff and enhance performance related to the quality and productivity of their audits.
• Working knowledge of applicable industry-based standards.
• Excellent verbal and written communication skills.
• Ability to work well in both individual and team environments.

Mental Requirements

• Communicating with others to exchange information.
• Problem-solving and critical thinking.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness, and thoroughness of assigned work.
• Learning new tasks and completing tasks in situations with speed or productivity quotas.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

Working Conditions and Physical Requirements

• 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 high-speed internet access/connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Pay

Base compensation ranges from $112,000 to $132,000 per year. Specific offers are determined by various factors, including experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Benefits

• 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.