Cotiviti

Auditor Technical Trainer – DRG

Cotiviti

full-time

Posted on:

Location Type: Remote

Location: United States

Visit company website

Explore more

✨ AI Apply
Apply

Salary

💰 $105,000 - $125,000 per year

About the role

  • This role is part of the training team for the Clinical Chart Validation team.
  • This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment.
  • The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.
  • Assess job-specific needs and develop technical training plans with clear business objectives, including working with subject matter experts, developing training materials, and developing appropriate assessments and measurements of success.
  • Select training/instructional methods and procedures appropriate for the situation when learning or teaching new skills.
  • Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar.
  • Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills.
  • Provide support to the CCV audit team members; assist with orientation of new members as needed, mentor new team members after orientation.
  • Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings.
  • Encourage critical thinking and discussion among team members on concepts as needed.
  • Provide training on one or more of the following audit types: Outpatient and Specialty Review Types to include SNF, IRF, and HH.
  • Train Clinicians with coding certifications on coding principles.
  • Confer with management and conduct surveys to identify training needs based on projected production processes, changes, and other factors.
  • Participate in weekly/monthly team meetings to share best practices initiatives and recommend audit vulnerabilities.
  • Support the Medical Director to ensure accurate assessments of improper payments are based on consistent application of clinical guidelines.
  • Assess customer/provider/stakeholder issues, complaints, and compliments.
  • Monitor/Assess the performance of self, other individuals, &/or organizations to make improvements or recommend remediation or corrective action.
  • Work with the Quality Team to train audit team members on findings from quality review audits.
  • Develop testing and evaluation procedures.
  • Evaluate instructor performance and the effectiveness of training programs, providing recommendations for improvements.
  • Conduct or arrange for ongoing technical training and personal development classes for staff members.
  • Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews.
  • Draw on healthcare proficiency and industry knowledge to substantiate conclusions.
  • Perform work independently, review and interpret audit work of others. Depending on the nature and scope of the audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns.
  • Demonstrate an understanding of complex contract specifications when performing medical record reviews.
  • Use healthcare expertise to determine approval or referral to the Medical Director.
  • Provide feedback on reviews to the Quality Assurance Manager as indicated in order to assist with the improvement of rationales sent to providers.
  • Develop reasonable and effective recommendations for concept solutions that reflect an understanding of the client environment and risks inherent to our business and industry.
  • Suggest and or develop and implement new ideas, approaches, decision trees, and/or technological improvements that will support and optimize audit results.
  • Collaborate with Data Services in developing new reports.
  • In addition to regular and predictable attendance, maintain production goals and quality standards set by the audit.
  • Performs QA audits against the expected level of quality and quantity (i.e. hit rate, # claims written, ID per hour).

Requirements

  • Associates Degree or equivalent relevant experience required
  • Bachelor’s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business, preferred, or 5 – 7 years of relevant experience
  • Clinical /Nursing experience in an SNF, IRF, and HH setting is required
  • Coding certification is required and maintained as a condition of employment (CCS, CPC, etc.)
  • Candidates who hold a CCDS will also be given consideration but will need to obtain a coding certification within 6 months.
  • 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, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
  • Requires expert coding knowledge - CPT and HCPCS codes.
  • Strong presentation skills.
  • Comfortable in presenting/defending audit logic to clients and key stakeholders (i.e. hospitals, physicians, validation contractors, auditing team, etc.)
  • Independent thinker, logical, strategic, with a high focus and attention to detail.
  • Effective communication and presentation style (written and verbal) with proven ability to positively influence behavior and outcomes.
  • Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
  • Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines.
  • Professional demeanor: Ability to creatively solve problems, deal with ambiguity, develop and implement policy and procedures, perform analysis and prepare reports, and foster team building.
  • High level of proficiency with all audit technology i.e., R3, CAT, etc.
  • Proficiency in Word, Access, Excel, PowerPoint and other applications.
  • Excellent written and verbal communication skills.
  • Applicants should have home health, IRF, and SNF experience.
Benefits
  • 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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
coding certificationCPT codesHCPCS codesmedical claimsbilling/payment systemsprovider billing guidelinespayer reimbursement policiesmedical necessity criteriacurriculum designtraining design
Soft Skills
presentation skillseffective communicationindependent thinkerstrategic thinkingattention to detailproblem-solvingteam buildingorganizational skillsmultitaskinginfluencing behavior
Certifications
CCSCPCCCDS