Team Lead Senior Auditor CCV (Place of Service, Short-Stay, Readmission)
$112,000–$132,000 year
RemoteUnited States
Job Summary
Oversee a team of Clinical Validation Auditors to ensure quality outcomes, manage work distribution, and optimize individual performance against client SLAs. Lead training, coaching, and onboarding while serving as the first-level resource for complex claims and clinical industry standards questions. Monitor team productivity using data analytics to identify outliers, track system downtime, and implement process improvements for cost containment. Collaborate with HR on performance management and talent retention, ensuring all operational controls and Cotiviti protocols are followed. Elevate provider suggestions to leadership and complete annual goals and special projects as assigned.
Required Qualifications
- Associate or Bachelor's degree in nursing
- RN License (active /unrestricted in state of residence)
- Computer proficiency in Microsoft Excel, Access and system databases
- 2+ years' prior management or supervisory experience
- 5+ years of related experience in: Auditing, Quality or Appeals focused on these types of audits: Place of Service, Short Stay & Readmission
- Requires working knowledge of and applicable industry-based standards
- Excellent verbal and written communication skills
- Ability to work well in an individual and team environment
- Ability to mentor staff and enhance performance as it relates to the quality and productivity of their audits
- 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
Desired Qualifications
- Case Management Certification (preferred)
- Coding or Clinical Documentation Certification (preferred)
- Prior Healthcare Billing and/or claims experience desired, but not required
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