Auditor Technical Trainer – Outpatient/Specialty Audits

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $105k - $125k / 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 the Clinical Chart Validation team • Assess job-specific needs and develop technical training plans with clear business objectives • Collaborate with subject matter experts across Commercial & Government Audit Teams, Quality Assurance, Concept Development, and other groups • Develop training materials, assessments, and measurements of success • Select appropriate training and instructional methods • Deliver classroom, online, and webinar training sessions • Coach and mentor auditors and support orientation of new team members • Train auditors on Outpatient and Specialty Reviews, including SNF, IRF, HH, DME, Hospice, and medical necessity • Train clinicians with coding certifications on coding principles • Identify training needs based on production processes and changes • 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 • Develop testing and evaluation procedures and improve training-program effectiveness • Integrate healthcare auditing principles and objectivity into medical audit activities • Review and interpret audit work and, as needed, medical records for medical necessity, setting appropriateness, billing/coding issues, and quality concerns • Interpret complex contract specifications and determine approval or referral to the Medical Director • Provide feedback to the Quality Assurance Manager to improve provider rationales • Develop recommendations, decision trees, and technological improvements to optimize audit results • Collaborate with Data Services on new reports • Maintain production goals and quality standards • Perform QA audits against expected quality and quantity standards

🎯 Requirements

• Associate 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 may substitute for the preferred bachelor’s degree • 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 • 5 to 7+ years of experience working with medical claims, billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology • Experience in an SNF, IRF, and HH setting preferred • Applicants should have 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 and defend audit logic to clients and key stakeholders • Independent, logical, and strategic thinker with strong attention to detail • Effective written and verbal communication and presentation skills • Knowledge of curriculum and training design, teaching and instruction for individuals and groups, and measurement of training effects • Competent administrative and organizational skills; ability to multitask, prioritize, and meet deadlines • Ability to creatively solve problems, deal with ambiguity, develop and implement policies and procedures, perform analysis and prepare reports, and foster team building • High proficiency with audit technology, including R3 and CAT • Proficiency in Word, Access, Excel, PowerPoint, and other applications • Ability to provide a dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance required

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service