[Hiring] Audit Quality Specialist @Cotiviti

Role Description

The Audit Quality Specialist (AQS) is a member of the greater Data Mining and Coordination of Benefits business unit where Cotiviti employees are responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, the AQS is responsible for post-audit internally and externally for the quality and compliance of audit engagements, ensuring expectations are met as well as established standards and requirements. This team works closely with internal audit teams to provide guidance, support, and oversight throughout the audit process. This is an entry-level position supporting client requests, overpayment quality review, system reconciliation, and claim audit requests. Documentation of relevant facts, information, and conclusions drawn to support the work performed for leadership to review and provide feedback is an essential function of the role.

Responsibilities

• Provides Specialized Audit Quality Support:
  • Conduct quality reviews of audit documentation, work papers, and reports to ensure accuracy, completeness, and compliance with auditing standards and regulations.
  • Supports team leaders in reliably completing client requests, data management needs, and overpayment record review.
  • Reviews and analyzes claim data and documentation to revalidate claims to ensure accuracy according to established policies and procedures, which may at times also include contacting the client directly at the claim level.
  • Responsible for updating internal and external client systems with appropriate details to resolve claims.
  • Ensures individual access to systems by the client as upheld for integrity, accuracy, and reliability as well as completing assigned compliance training as requested.
• Generates and Analyzes Quality Audit Reports:
  • Provides support to leaders to review and complete supplier quality audit reports initiated by the client.
  • Documents system and process deficiencies identified through supplier quality audit work and communicates these deficiencies to the leader.
  • Communicates with client contacts and providers where necessary while following an established set of processes and procedures.
  • Review audit findings, conclusions, and recommendations to verify their validity and appropriateness based on the evidence gathered.
  • Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Supports Process Improvement:
  • Continuously analyzes processes and systems used during work to identify internal areas of improvement and proactively communicates feedback to leaders.
  • Identify areas for improvement in audit processes, procedures, and documentation, and collaborate with audit teams to implement.
• Governance:
  • Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements.
  • Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards.
  • Has a basic understanding of the healthcare industry, as well as a proven track record of delivering results.
  • Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
  • Complete all responsibilities as outlined in the annual performance review and/or goal setting.
  • Complete all special projects and other duties as assigned.
  • Must be able to perform duties with or without reasonable accommodation.

Qualifications

• High School or GED (Required).
• Bachelor’s degree in healthcare, accounting, finance, or related field (preferred) and/or a minimum of at least 1-2 year/s related experience in health care.
• At least 1-2 year/s Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Recovery Resolution, Audit Support, etc.).
• Ability to work effectively both independently and as part of a team.
• Proficiency in Microsoft Office suite (Word, Excel, PowerPoint).
• Strong interest in quality review and root cause identification/resolution.
• Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Requirements

• Analytical Skills: Strong analytical abilities to review and interpret complex financial data, identify patterns or discrepancies, and draw meaningful conclusions.
• Attention to Detail: Crucial in auditing to ensure accuracy and precision in reviewing documentation, performing testing procedures, and documenting findings.
• Problem-Solving Skills: Ability to identify problems, evaluate alternative solutions, and implement appropriate resolutions to ensure audit quality and compliance with standards.
• Critical Thinking: Ability to analyze complex situations, consider multiple perspectives, and make sound judgments based on evidence and reasoning.
• Communication Skills: Ability to articulate concepts clearly and concisely, both verbally and in writing and exercise discretion on confidential matters.
• Time Management: Ability to prioritize tasks, manage time efficiently, and meet deadlines while maintaining high-quality work.
• Ethical Judgment: Integrity and ethical judgment are paramount in auditing to ensure compliance with professional standards and regulations.

Benefits

• Base compensation ranges from $17.00 to $22.50 per hour.
• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.
• 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.