Auditor Technical Trainer – Outpatient/Specialty Audits

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $107k - $119k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Plan, develop, and deliver technical training, mentoring, and assessments for Clinical Chart Validation teams • Assess job-specific needs and develop technical training plans with business objectives • Collaborate with subject matter experts, audit teams, Quality Assurance, Concept Development, and other stakeholders • Develop training materials, assessments, testing, and evaluation procedures • Deliver classroom, online, and webinar training sessions • Coach, mentor, and support audit team members, including new-member orientation • Train auditors on Outpatient and Specialty Review Types, including SNF, IRF, HH, DME, Hospice, and medical necessity • Train clinicians with coding certifications on coding principles • Identify training needs based on production processes, changes, and other factors • Participate in team meetings, share best practices, and recommend audit vulnerabilities • Support the Medical Director in ensuring accurate improper-payment assessments • Assess customer, provider, and stakeholder issues, complaints, and compliments • Monitor performance and recommend remediation or corrective action • Train audit team members on Quality Team findings • Evaluate instructor performance and training-program effectiveness • Conduct or arrange ongoing technical training and personal-development classes • Perform healthcare audit and quality-assurance reviews using clinical criteria and coding expertise • Review medical records to determine medical necessity, setting appropriateness, billing/coding issues, and quality concerns • Interpret complex contract specifications and determine approval or referral to the Medical Director • Provide review feedback to the Quality Assurance Manager • Develop concept solutions, decision trees, approaches, and technology improvements • Collaborate with Data Services to develop new reports • Maintain productivity goals and audit quality standards, including hit rate, claims written, and ID per hour • Perform QA audits against expected quality and quantity levels

🎯 Requirements

• Associate’s 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, or 5–7+ years working with medical claims, billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology • Coding certification required and maintained as a condition of employment (CCS, CPC, etc.) • Candidates holding a CCDS must obtain a coding certification within 6 months • Experience in SNF, IRF, and HH settings preferred • Home health, IRF, and SNF experience • Expert knowledge of CPT and HCPCS codes • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates • Strong presentation skills and ability to present/defend audit logic to clients and key stakeholders • Knowledge of curriculum and training design, teaching and instruction for individuals and groups, and measurement of training effects • Administrative and organizational skills; ability to multitask, prioritize, and meet deadlines • Proficiency with audit technology such as R3 and CAT • Proficiency in Word, Access, Excel, PowerPoint, and other applications • Excellent written and verbal communication skills • Ability to provide a dedicated, secure work area and high-speed internet access/connectivity and office setup • Ability to communicate, problem-solve, think critically, complete tasks independently, remain stationary for prolonged periods, and perform repetitive wrist, hand, and finger motions

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(k) savings plan • 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 • Discretionary bonus consideration • Dedicated, secure work area and high-speed internet access/connectivity supported as work conditions

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