Auditor Technical Trainer – DRG

Role Overview

• 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