[Hiring] Auditor Technical Trainer @Cotiviti

Role Description

This role is part of the training team for the Clinical Chart Validation team. This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment. 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. This work is focused on Training for our Outpatient & Specialty Clinical & Coding Validation Audits.

Responsibilities

• Assess job-specific needs and develop technical training plans with clear business objectives.
• Work with subject matter experts, develop training materials, and create appropriate assessments and measurements of success.
• Select training/instructional methods and procedures appropriate for the situation.
• Deliver specific training sessions using suitable delivery methods such as classroom, online, and webinar.
• Identify the development needs of others and coach or mentor them to improve their knowledge and skills.
• Provide support to the CCV audit team members; assist with orientation of new members as needed.
• Promote audit accuracy measures by training/educating and mentoring the auditor.
• Encourage critical thinking and discussion among team members on concepts as needed.
• Provide training on various audit types: Outpatient and Specialty Review Types including SNF, IRF, HH, DME, Hospice, and medical necessity.
• Train Clinicians with coding certifications on coding principles.
• Confer with management and conduct surveys to identify training needs based on projected production processes.
• Participate in weekly/monthly team meetings to share best practices initiatives and recommend audit vulnerabilities.
• Support the Medical Director to ensure accurate assessments of improper payments.
• Assess customer/provider/stakeholder issues, complaints, and compliments.
• Monitor/Assess the performance of self, other individuals, &/or organizations to make improvements.
• Work with the Quality Team to train audit team members on findings from quality review audits.
• Develop testing and evaluation procedures; evaluate instructor performance and the effectiveness of training programs.
• Conduct or arrange for ongoing technical training and personal development classes for staff members.
• Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews.
• Perform work independently, review and interpret audit work of others.
• Review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity.
• Demonstrate an understanding of complex contract specifications when performing medical record reviews.
• Provide feedback on reviews to the Quality Assurance Manager to assist with improvement.
• Develop reasonable and effective recommendations for concept solutions.
• Suggest and/or develop and implement new ideas, approaches, and/or technological improvements.
• Collaborate with Data Services in developing new reports.
• Maintain production goals and quality standards set by the audit.
• Perform QA audits against the expected level of quality and quantity.

Qualifications

• Associates Degree or equivalent relevant experience required.
• Bachelor’s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business preferred.
• 5 – 7 years of relevant experience in claims auditing/quality assurance/recovery auditing.
• Experience in an SNF, IRF, and HH setting is preferred.
• Coding certification is required and maintained as a condition of employment (CCS, CPC, etc.).
• 5 to 7+ years of working with a broad knowledge of medical claims, billing/payment systems, and coding terminology.
• Adherence to official coding guidelines and CMS regulatory compliance guidelines.
• Strong presentation skills and comfortable in presenting/defending audit logic to clients.
• Independent thinker, logical, strategic, with a high focus and attention to detail.
• Effective communication and presentation style (written and verbal).
• Knowledge of principles and methods for curriculum and training design.
• Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines.
• Professional demeanor with problem-solving skills.
• 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.

Requirements

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

Benefits

• Base compensation ranges from $107,000 to $119,000 per year.
• Eligible for discretionary bonus consideration.
• 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.