Senior Manager, Audit Operations (CCV)

Cotiviti

26d • Remote

About The Position

The Sr. Manager, Audit Operations is responsible for leading the Clinical Chart Validation (CCV) audit operation, managing the audit team’s performance and productivity, ensuring client SLA’s and budget commitments are achieved, claim workflow is uninterrupted, and talent management is prioritized. This particular Sr. Manager role has expanded process improvement responsibilities across the CCV Audit including vendor management, NLP program oversight and serves as the lead on other process improvement initiatives designed to optimize team efficiency through automation and other means. This role will have 4-6 direct reports and up to 90 indirect reports.

Requirements

• Bachelor's degree is required.
• RN license and/or Coding Certification is required.
• Prefer 5+ years of related audit experience
• At least 5-7 years of management experience required; people management experience is required
• Proven ability to successfully manage a team and collaborate with others.
• Excellent verbal and written communication skills required.
• Advanced computer skills in Excel and Access required.
• Strong working knowledge and understanding of clinical and coding audits preferred.
• Manage multiple client deliverables and competing deadlines simultaneously.
• Experience in working directly with clients to communicate production and quality accuracy details.
• Awareness and adherence to HIPAA privacy and security regulations.
• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands and/or fingers.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Responsibilities

• Accountable for overseeing process improvement strategic initiatives that primarily lead to measurable audit efficiencies and cost savings; with associated increased revenue.
• Works closely with Audit Leadership colleagues and personnel to continuously identify improvement opportunities, formulate improvement plans, and facilitate the execution of such plans.
• Oversees the Natural Language Processing program ensuring value is optimized through NLP rule and UI optimization, auditor proficiency with the tool, and vendor collaboration.
• Leads vendor management oversight and serves as the contractual liaison for software support.
• Provides day-to-day supervision and direction to assigned audit Team Leads. Ensures operations are running optimally and processes and procedures are being followed.
• Ensures appropriate staffing levels and plans and organizes workloads and staff assignments according to the needs of the audit. Manages the overall performance, productivity, and quality of the assigned audit teams. Maximizes opportunities of the audit; optimizes timely audit processes and efficiencies.
• Involved in formulating all budget related aspects of the audit. Executes and adjusts to budget demands. Drives the profitability of the audit engagement.
• Consistent with good people management practices and company values, providing managerial leadership and directing the selection, supervision, evaluation, and development of staff. Set objectives and conduct performance reviews for direct reports and oversee the remaining evaluations for indirect team members.
• Work with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolve employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines.
• Follow established processes for training and career progression to enable revenue growth and auditor and support staff development and engagement. Promote & participate in knowledge sharing activities such as best practices, benchmarking, whitepapers, and IT tools enhancement. Ensure that all levels of staff are properly trained on policies, procedures and best practices and that proper training, education and required certifications are maintained as required.
• Innate ability to share knowledge and develop audit skills in others. Broadly fosters formal and informal knowledge sharing activities.
• Assigns proportionate workload to team that yields maximum productivity and achievable, profitable results.
• Always goes over and above what is expected in seeking and sharing ideas in a positive and productive way. Considered go to person for root cause process improvements. Capitalizes on audit resources to extend current or business capabilities, ensuring that client demands are met in the short and long term.
• Treats customers/clients both internal and external as number one priority, is committed to continuous quality improvement, is courteous and responsive to customer's needs, meets or exceeds all customer commitments and treats customers honestly.
• Direct accountability for overall Quality Control Process within the audit. Demonstrates advanced expertise and comprehension (knowledge) of claim categories, claim types. Holds the Audit team accountable for ensuring submission and execution of quality work, proper use of available proprietary software, reports, and IT resources to conduct audits.
• Demonstrates understanding of Cotiviti policies & procedures Assures confidentiality and security of all data. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
• Maintains strict adherence to organizational values for both Cotiviti and client.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Benefits

• Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees