Auditor, Technical Trainer - POS

🕒 July 13

🇺🇸 United States – Remote

💵 $105k - $125k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 • Work with subject matter experts to develop training materials, assessments, and success measurements • Select appropriate training and instructional methods • Deliver classroom, online, and webinar training sessions • Coach, mentor, and assist team members in improving their knowledge and skills • Support CCV audit team members and assist with new-member orientation and mentoring • Promote audit accuracy through auditor training, education, mentoring, and documented validated findings • Encourage critical thinking and discussion among team members • Provide training on Place of Service and Readmission audits • Identify training needs based on projected production processes, changes, and other factors • Participate in weekly/monthly team meetings, share best practices, and recommend audit vulnerabilities • Support the Medical Director in ensuring accurate improper-payment assessments based on consistent clinical-guideline application • Assess customer, provider, and stakeholder issues, complaints, and compliments • Monitor and assess performance and recommend remediation or corrective action • Train audit team members on Quality Team findings • Develop testing and evaluation procedures and evaluate instructor and training-program effectiveness • Conduct or arrange ongoing technical training and personal-development classes • Integrate healthcare auditing principles and objectivity into medical audit activities and reviews • Review and interpret others' audit work independently • Review medical records and apply clinical criteria to determine medical necessity, setting appropriateness, billing/coding issues, and quality concerns as needed • Interpret complex contract specifications during medical-record reviews • Use healthcare expertise to determine approval or referral to the Medical Director • Provide review feedback to the Quality Assurance Manager • Develop and implement concept solutions, decision trees, and technological improvements to optimize audit results • Collaborate with Data Services to develop new reports • Maintain audit production goals and quality standards • Perform QA audits against expected quality and quantity standards

🎯 Requirements

• Associate or Bachelor's degree in nursing • Active, unrestricted RN license in state of residence • 5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation) • Background in Utilization Management and/or Case Management • Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg • 5 to 7+ years of working with a broad knowledge of medical claims, billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology • Adherence to official coding guidelines and other regulatory compliance guidelines and mandates • Expert-level knowledge of InterQual and/or MCG criteria • Strong presentation skills and ability to present/defend audit logic to clients and key stakeholders • Independent, logical, strategic thinker with high focus and attention to detail • Effective written and verbal communication and presentation skills, with proven ability to positively influence behavior and outcomes • 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, set priorities, 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 • Excellent written and verbal communication skills • Home health, IRF, and SNF experience • Ability to communicate, problem-solve, think critically, and complete tasks independently • Ability to remain stationary, often standing or sitting for prolonged periods • Ability to perform repetitive motions involving wrists, hands, and/or fingers • Ability to provide a dedicated, secure work area and high-speed internet access/connectivity with office setup and maintenance

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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 • Dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance