Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. We are seeking innovative thinkers and creative problem solvers who are interested in contributing to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. This role can be based in any of our Cotiviti office locations.
The Director, Audit Operations position is responsible for providing leadership and management for one or more accounts or significant audit projects. Oversees all audit activities for assigned account to maximize valid claim identification and overpayment recoveries, meet contractual commitments, and deliver customer satisfaction consistent with established operating practices and audit procedures. This will be accomplished through effective audit operations management, quality and service assurance, and effective people management and development. Effectively able to manage through metrics.
- Audit Service Delivery. Directs the successful delivery of audit services to the client by managing the team(s) assigned to the engagement and providing leadership and direction and ensuring that the client’s needs and expectations are met and exceeded. Develops and implements key metrics to drive performance in quality and productivity and to ensure that the customer experience is consistent and satisfactory across all phases of the audit.
- Audit Productivity. Reviews audit progress against established metrics and direct activities as needed to ensure achievement of business goals and customer expectations. Ensures effective coordination with Business Optimization and other support functions to achieve audit goals. Demonstrates awareness and sensitivity to the needs of the client, the needs of the audit team, and the profitability of the audit engagement.
- Cost Management. Continually work to improve efficiency, productivity and reduce operational costs while providing 100% compliance with customer contract and company policies.
- Quality and Continuous Improvement. Supports the continuous development of innovative solutions and audit concepts with audit team. Works to optimize audit processes and efficiencies.
- Customer Service. Effectively manages customer problems and conflict, including direct communication with customers to achieve mutually accepted resolution. Provides assistance and removes barriers as needed to identify opportunities for process improvements. Serves as top escalation point to resolve any customer issues that are roadblocks to customer satisfaction. Leads the implementation of all appropriate actions by other leaders and teams to understand and resolve issue and ensures follow through until closure and complete customer satisfaction.
- Account Growth. Ensures the audit team is looking at all possible claim categories and claim types and is using all available proprietary software, reports and IT resources to conduct their audits. Collaborates with SAM to achieve in growth opportunities within existing and potential clients.
- Compliance. Ensures compliance all HIPAA regulations regarding the safeguarding of Protected Health Information (PHI) and communicate to all associates involved in the audit engagement.
- Contract Management. Partners with the client and sales team on renewals and work through any RFP process by identifying gaps in current contract in place and understanding customer needs in order to successfully renew the contract. Performs customer needs and service analysis, makes recommendations on appropriate pricing structure and contract requirements, and contribute to RFP responses. Facilitates contract terminations or scope changes including identifying reason for change, defining possible solutions to customer issues to lead to retention, negotiating account transition procedures and prices
- Audit Staffing. Meets regularly with audit and audit support managers to ensure appropriate staffing levels and to plan and organize workloads and staff assignments according to the needs of the audit.
- People Management. Consistent with good people management practices and company values. Provides managerial leadership and direct the selection, supervision, evaluation and development of staff. Sets objectives and conducts performance reviews for direct reports and oversees the remaining evaluations indirect team members.
- Performance Management. Works with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolves employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines.
- Staff Training & Development. Follow established processes for training and career progression to enable revenue growth and auditor and support staff development and engagement. Promotes & participates in knowledge sharing activities such as best practices, benchmarking, whitepapers and IT tools enhancement. Ensures that all levels of staff are properly trained on policies, procedures, best practices, and that proper training, education and required certifications are maintained as required.
- Succession Planning. Proactively plan for succession and growth and ensures no gap in productivity and customer service.
What we're looking for:
- Bachelor’s Degree preferred
- 5 years healthcare auditing, claims or healthcare billing experience required
- Prior experience with direct client contact (account management, audit, sales, etc.) required
- Computer proficiency in Microsoft Excel, Access and claim databases
- Excellent verbal and written communication skills
- 5 years people management experience (preferably managing large teams) required
- Strong ability to manage and create action from metrics
- Budgeting/forecasting experience
- Demonstrated leadership and relationship building skills across functions and business lines
- Client-facing experience (account management, audit, sales)
- Ability to manage multiple projects in a timely manner, while working in a fast paced environment
- Requires working knowledge of and applicable industry based standards
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