Auditor Technical Trainer – Outpatient/Specialty Audits

This is a fully remote position, open to applicants in United States.

📋 Description

• Design, implement, and facilitate technical training, mentoring, and evaluations for the Clinical Chart Validation team.

• Evaluate specific job-related needs and create technical training plans aligned with clear business goals.

• Collaborate with subject matter experts from the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and other departments.

• Create training materials, assessments, and success metrics.

• Choose suitable training and instructional methodologies.

• Conduct classroom, online, and webinar training sessions.

• Mentor and coach auditors while aiding in the orientation of new team members.

• Educate auditors on Outpatient and Specialty Reviews, which include SNF, IRF, HH, DME, Hospice, and medical necessity.

• Instruct clinicians with coding certifications on coding principles.

• Identify training requirements based on production processes and adjustments.

• Participate in team meetings, exchange best practices, and suggest audit vulnerabilities.

• Assist the Medical Director in ensuring the accuracy of improper-payment assessments.

• Evaluate issues, complaints, and accolades from customers, providers, and stakeholders.

• Monitor performance and suggest remediation or corrective actions.

• Train audit team members based on findings from the Quality Team.

• Create testing and evaluation protocols to enhance training program effectiveness.

• Incorporate healthcare auditing principles and objectivity into medical audit tasks.

• Review and analyze audit work, and when necessary, medical records for medical necessity, setting appropriateness, billing/coding issues, and quality concerns.

• Interpret complex contract specifications and decide on approval or referral to the Medical Director.

• Provide insights to the Quality Assurance Manager for enhancing provider rationales.

• Develop recommendations, decision trees, and technological enhancements to maximize audit outcomes.

• Work alongside Data Services on new reporting initiatives.

• Maintain production targets and uphold quality standards.

• Conduct QA audits to align with expected quality and quantity criteria.

⛳️ Requirements

• Associate Degree or equivalent relevant experience is mandatory.

• A Bachelor’s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business is preferred.

• 5–7 years of relevant experience may compensate for the preferred bachelor’s degree.

• A coding certification is required and must be maintained as a condition of employment (CCS, CPC, etc.).

• Applicants with a CCDS must acquire a coding certification within 6 months.

• 5 to 7+ years of experience with medical claims, billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology is essential.

• Experience in SNF, IRF, and HH settings is preferred.

• Candidates should possess experience in home health, IRF, and SNF.

• In-depth knowledge of CPT and HCPCS codes is crucial.

• Compliance with official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance directives is required.

• Strong presentation abilities and capacity to articulate and defend audit logic to clients and key stakeholders.

• Independent, logical, and strategic thinker with meticulous attention to detail.

• Excellent written and verbal communication and presentation skills.

• Understanding of curriculum and training design, teaching methodologies for individuals and groups, and assessment of training effectiveness.

• Proficient administrative and organizational skills; capable of multitasking, prioritizing, and meeting deadlines.

• Ability to creatively address problems, manage ambiguity, develop and implement policies and procedures, conduct analyses, prepare reports, and promote team collaboration.

• High proficiency with audit technology, including R3 and CAT.

• Proficient in Word, Access, Excel, PowerPoint, and other applications.

• Capability to provide a dedicated, secure workspace.

• Required high-speed internet access/connectivity and office setup and maintenance.

🏝️ Benefits

• Discretionary bonus eligibility.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance options.

• Life insurance benefits.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service.