Team Lead, Senior Auditor – CCV

🔥 15 minutes ago

🇺🇸 United States – Remote

💵 $112k - $132k / year

⏰ Full Time

🟠 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

• Supervise a team of Clinical Validation Auditors or other audit team members • Manage queue flow, work distribution, audit planning, and team performance • Ensure audits meet productivity standards, quality guidelines, client SLAs, and clinical validation standards • Optimize individual and team production, accuracy, and quality deliverables • Train, onboard, coach, mentor, review, and retain audit staff • Serve as the first-level resource for claim-specific and clinical industry-standard questions • Collaborate with Quality Assurance, the Audit Manager, and Human Resources on performance management and employee relations • Develop and implement remediation efforts and process improvements • Coordinate hiring and retention of top talent • Capture system issues for IT escalation and track and report downtime • Distribute work strategically to ensure timely completion and optimized results • Use data and analytic techniques to monitor client performance and remediate outliers • Provide metrics including hours worked, members reviewed, calls made, claims written, and dollars found • Escalate provider and client suggestions and concerns and offer solutions • Complete performance-review responsibilities, special projects, and other assigned duties

🎯 Requirements

• Associate or Bachelor's degree in nursing • Active, unrestricted RN license in state of residence • 5+ years of related experience in auditing, quality, or appeals focused on Place of Service, Short Stay, and Readmission audits • 2+ years of prior management or supervisory experience preferred • Case Management Certification preferred • Coding or Clinical Documentation Certification preferred • Computer proficiency in Microsoft Excel, Access, and system databases • Prior healthcare billing and/or claims experience desired, but not required • Ability to mentor staff and enhance audit quality and productivity • Working knowledge of applicable industry-based standards • Excellent verbal and written communication skills • Ability to work independently and in a team environment • Ability to provide high-speed internet access/connectivity and office setup and maintenance • Dedicated, secure work area required • Ability to remain stationary, often standing or sitting for prolonged periods • Ability to repeat motions involving the wrists, hands, and/or fingers • Ability to communicate, solve problems, interpret data, make timely workflow decisions, maintain focus, assess accuracy and thoroughness, learn new tasks, meet productivity quotas, and adhere to protocols

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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 level and length of service