Auditor Technical Trainer (Outpatient/Specialty Audits)

Cotiviti•Remote,

6d•$107,000 - $119,000•Remote

About The Position

The Auditor Technical Trainer is part of the Clinical Chart Validation team’s training group and improves team technical effectiveness through training, mentoring, and assessment. The role plans, develops, and delivers technical training and collaborates with subject matter experts in Commercial and Government Audit Teams, Quality Assurance, Concept Development, and other groups to validate workflows and communication tools that support audit productivity, performance, and client satisfaction. The training focus is Outpatient and Specialty Clinical and Coding Validation Audits, including audit types such as SNF, IRF, home health, DME, hospice, and medical necessity. The trainer also supports audit quality and operations by interpreting healthcare audit principles, reviewing and assessing audit work, applying clinical criteria and contract specifications when appropriate, and providing feedback to quality and management teams. The position develops recommendations and process improvements, supports training on quality findings, and maintains production and quality standards. The role requires a dedicated, secure work area, high-speed internet connectivity, and an office setup. No adverse environmental conditions are expected.

Requirements

Associate degree or equivalent relevant experience.
Coding certification (such as CCS or CPC), maintained as a condition of employment. Candidates with a CCDS may be considered but must obtain a coding certification within six months.
Five to seven or more years of experience with broad knowledge of medical claims, billing and payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
Expert coding knowledge, including CPT and HCPCS codes, and adherence to official coding guidelines, Coding Clinic determinations, CMS requirements, and other regulatory compliance guidelines and mandates.
Strong presentation skills and comfort presenting and defending audit logic to clients and stakeholders, including hospitals, physicians, validation contractors, and audit teams.
Independent, logical, and strategic thinking, with strong focus and attention to detail.
Effective written and verbal communication and presentation skills, with the 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.
Administrative and organizational competence, including multitasking, prioritization, and meeting deadlines.
Professional demeanor and ability to solve problems creatively, handle ambiguity, develop and implement policies and procedures, perform analysis, prepare reports, and foster teamwork.
High proficiency with audit technology such as R3 and CAT.
Proficiency with Word, Access, Excel, PowerPoint, and other applications.
Excellent written and verbal communication skills.
Ability to communicate to exchange information, solve problems and think critically, and complete tasks independently.
Ability to remain stationary, often standing or sitting for prolonged periods, and perform repeated motions involving the wrists, hands, or fingers.
Ability to provide a dedicated, secure work area, high-speed internet access/connectivity, and office setup and maintenance.

Nice To Haves

Bachelor’s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business.
Five to seven years of relevant experience in claims auditing, quality assurance, or recovery auditing as an alternative to the preferred bachelor’s degree.
Experience in SNF, IRF, and home health settings.
Applicants should have home health, IRF, and SNF experience.

Responsibilities

Assess job-specific training needs and develop technical training plans with business objectives, working with subject matter experts to create materials, assessments, and success measures.
Select appropriate instructional methods and deliver training through classroom, online, webinar, or other suitable formats.
Coach, mentor, and support team members, including assisting with new-member orientation and mentoring after orientation.
Promote audit accuracy through training, education, mentoring, and documented, validated findings.
Encourage critical thinking and discussion among team members.
Provide training on outpatient and specialty reviews, including SNF, IRF, home health, DME, hospice, and medical necessity; train clinicians with coding certifications on coding principles.
Consult management and conduct surveys to identify training needs related to production processes, changes, and other factors.
Participate in team meetings to share best practices and recommend audit vulnerability measures.
Support the Medical Director in ensuring improper-payment assessments consistently apply clinical guidelines.
Assess customer, provider, and stakeholder issues, complaints, and compliments.
Monitor and assess individual and organizational performance and recommend improvement, remediation, or corrective action.
Work with the Quality Team to train audit team members on quality-review findings.
Develop testing and evaluation procedures; evaluate instructors and training-program effectiveness; recommend improvements; and conduct or arrange ongoing technical and personal-development training.
Apply healthcare auditing principles objectively and use healthcare expertise and industry knowledge to substantiate conclusions.
Work independently and review and interpret the audit work of others.
As appropriate to the audit, review medical records and apply clinical criteria to assess medical necessity, setting appropriateness, potential billing or coding issues, and quality concerns.
Interpret complex contract specifications in medical record reviews and use healthcare expertise to determine approval or referral to the Medical Director.
Provide review feedback to the Quality Assurance Manager to help improve rationales sent to providers.
Develop effective concept recommendations that account for client environments and business and industry risks.
Suggest or develop and implement ideas, approaches, decision trees, and technology improvements to support audit results.
Collaborate with Data Services to develop reports.
Maintain regular, predictable attendance and meet audit production goals and quality standards.
Perform QA audits to expected quality and quantity standards, including hit rate, claims written, and IDs per hour.