Cotiviti
Website:
cotiviti.com
Job details:
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The Team Lead is responsible for overseeing the daily operations of the audit team, ensuring efficiency, accuracy, and compliance in claim reviews. This role builds upon the Team Coach position by adding leadership responsibilities such as performance management, workflow oversight, and team engagement. The Team Lead is a critical link between auditors and management, ensuring audit targets are met while fostering a culture of continuous improvement and professional development
Requirements:
- Bachelor’s degree mandatory.
- Overall 7+ years of experience of which 1 + year as Team Lead or equivalent
- Proficiency of MS Office (Word, Excel) required.
- Must be detail-oriented and flexible to work in a fast-paced, dynamic environment.
- Strong analytical, critical thinking and problem solving skills.
- Team player with strong desire to assist others and share knowledge
- Excellent verbal and written communication skills
- Open to work in any shift including night shift
Principal Responsibilities and Essential Duties:
- Team Leadership: Supervise and manage a team of Payment Accuracy Specialists and Senior Specialists, ensuring productivity and quality targets are met. Address and resolve team challenges, escalations, and process bottlenecks to ensure smooth operations.
- Ensure Team Performance: Monitor team performance, track key performance indicators (KPIs), and implement corrective actions when necessary.
- Audit Oversight: Ensure audit workflows are executed efficiently and maintain high accuracy levels in claim reviews. Review and approve audit findings for high-value or complex claims before submission.
- Data Analysis: Utilize internal tools and databases to assess claim accuracy and detect patterns of incorrect billing. Utilize data analytics tools to detect payment trends, anomalies, and fraud indicators. Develop and refine audit methodologies to improve accuracy and efficiency. Assist in process improvement initiatives by identifying workflow enhancements.
- Quality Control: Work closely with quality audit teams to identify trends, errors, and areas for improvement. Enforce compliance with payer policies, regulatory guidelines, and internal audit standards.
- People Management: Maintain efficient workflow by holding direct reports accountable for the quality and efficiency of their work. Build and maintain positive internal working relationships with all department employees by communicating in a professional manner. Provides visual and verbal support to the team by remaining accessible.
- Performance Management: Provide guidance and effectively coach employees to achieve desired results and overall performance, encourage discussions to achieve long-term growth. Ensure all direct reports execute objectives using a developmental plan/ninety (90) day plan and regular performance reviews, posting productivity, quality and deadline results. Maintain consistency in applying company and departmental policy decisions by accurately and timely documenting employee files, including attendance, performance information, documented warnings, time off requests, coaching information, training information.
- Performance Review: Conduct regular performance reviews, coaching sessions, and feedback discussions to drive individual and team development.
- Process Optimization & Strategic Initiatives: Identify process inefficiencies and workflow gaps, recommending improvements to enhance accuracy and efficiency. Assist in developing and implementing best practices, SOPs, and automation initiatives to improve audit performance. Collaborate with cross-functional teams, including IT, data analytics, and compliance, to refine auditing methodologies.
- Stakeholder Management & Communication: Serve as the primary point of contact between team members, senior management, and other departments. Provide regular reports, data insights, and performance updates to leadership on audit trends, challenges, and results. Address client queries, payer feedback, or escalated disputes related to claim audit outcomes.
- Training & Development: Support onboarding, mentoring, and upskilling initiatives for new and existing team members. Foster a collaborative learning environment, encouraging team members to stay updated on industry trends and coding changes. Organize knowledge-sharing sessions and skill development programs in coordination with the SME/Team Coach.
- Escalations: Review escalated claims/appeals, guiding the team on complex claim adjudication and reimbursement policies.
- Reports & Presentations: Prepare and deliver reports, presentations, and audit insights to management for continuous improvement.
- Critical Thinker: Demonstrates adeptness in identifying errors and exceptions that result in valid claims. Has an eye for irregularities. Ability to analyze data, identify inconsistencies and formulate workable solutions. Makes logical, well-reasoned and timely decisions.
- Initiative Taker: Shows initiative and a willingness to engage in all areas of the audit. Reaches beyond current tasks to add value to audit team. Goes the extra step to solving problems instead of waiting for someone else to solve them. Successfully integrates and multi-tasks new assignments.
- Technically Capable: Demonstrates competency with tools of the job including but not limited to computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, and data file structures. Can efficiently download and format common file types.
- Policy Compliance: Ensure compliance with payer policies, contractual agreements, and industry regulations.
- Delivers Results: Delivers results consistently with high level of integrity. Meets or exceed goals at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.
- Performance Improvement and Feedback Implementation: Improve performance based on the feedback provided by the reporting manager.
- Time Management: Ensures timely completion of audit reports. Exhibit's an understanding of audit planning activities and uses a structured and dependable approach to accomplishing assigned work.
- 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.
Regards
Talent Acquisition Team | COTIVITI
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