Policy Quality Auditor I

Overview:

The Policy Quality Auditor I role is responsible for ensuring the accuracy of new policies and current policies for existing healthcare clients. This role serves as the final checkpoint in validating the accuracy of developed and processed work orders created and configured for rules.

• Validate the accuracy of new policies being implemented and existing policies for clients
• Ensure the capture and completion of project requests and processed work orders are validated accurately per policy; confirm corrections are made (if needed) by the desired completion date
• Generate all necessary reports for each project to validate accuracy
• Communicate effectively and timely with upstream functional areas to resolve issues
• Meet daily and monthly production and quality targets
• Maintain an exemplary level of accuracy in all work
• Actively monitoring queues to ensure all requests are executed per the allocated deadlines
• Thoroughly document all peer and audit findings through internal software tracking application as well as on the work orders
• Monitor Industry Update applications to ensure all audit is complete against appropriate decisions taken, successfully implemented, and documented accordingly
• Accurately assesses the impact, benefits, and risks associated with the best course of action and makes high quality and timely decisions
• Work closely with Policy Design, Configuration, and Integration teams to ensure timely response to client requests

Education/Certification: 

• High School diploma required
• Bachelor’s degree preferred or equivalent experience
• Prefer CPC (Certified Professional Coders), CCS, or RHIA certification

Requirements: 

• 1 to 2 years Cotiviti experience or industry experience
• Knowledge of CPT-4, ICD-10-CM, HCPCS coding, and medical terminology
• Familiar with medical terminology and medical claim life cycle
• Knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Knowledgeable in creating, reviewing, and analyzing reports
• Excellent written and verbal communication skills
• Presents information and ideas in a thoughtful and compelling manner with individual SMEs (subject matter experts) or team to achieve results
• Able to learn and apply new material
• Adapt quickly and easily to the latest information, changing conditions or unexpected events
• Team player with an ardent desire to assist others and share information freely
• Self-starter, with strong confidence level to perform responsibilities independently
• Sets clear priorities, takes action, stays focused, and overcomes barriers to deliver expected results
• Evaluates critical information needed to understand problems, determine probable causes, and develops workable solutions
• Ensure the security of confidential and sensitive information
• Seeks to understand the perspective of others in a team environment
• Able to handle multiple tasks, prioritize and meet deadlines

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• 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 a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Base compensation ranges from $24.00 to $29.00. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

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. For information about our benefits package, please refer to our Careers page.

Date of posting: 10/28/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 12/28/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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