Cotiviti · 1 month ago
Auditor Technical Trainer (Outpatient/Specialty Audits)
United States
Full-time
Remote
Mid, Senior Level
$105K/yr - $125K/yr
5+ years expCotiviti is a company focused on healthcare auditing and training. The Auditor Technical Trainer role involves enhancing the technical skills of audit teams through the development and delivery of training programs, while also ensuring quality assurance in healthcare auditing practices.
Information Technology & Services
Responsibilities
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
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)
Qualification
Required
Associates Degree or equivalent relevant experience required
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.)
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
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
Preferred
Bachelor's degree in Nursing, Healthcare Economics, Health Information Management, and/or Business
Candidates who hold a CCDS will also be given consideration but will need to obtain a coding certification within 6 months
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
Company
Cotiviti
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.
5001-10000 employees
H1B Sponsorship
Cotiviti has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (165)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
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