Auditor Technical Trainer – Outpatient/Specialty Audits

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

📋 Description

• Design, implement, and conduct technical training, mentorship, and evaluations for Clinical Chart Validation teams.

• Evaluate job-specific requirements and create technical training strategies aligned with business goals.

• Partner with subject matter experts, audit teams, Quality Assurance, Concept Development, and other relevant stakeholders.

• Create training resources, assessments, testing methodologies, and evaluation processes.

• Facilitate classroom, online, and webinar training sessions.

• Guide, mentor, and assist audit team members, including onboarding of new staff.

• Educate auditors on Outpatient and Specialty Review Types, covering SNF, IRF, HH, DME, Hospice, and medical necessity.

• Train clinicians with coding certifications on coding fundamentals.

• Identify training requirements stemming from production workflows, changes, and other variables.

• Attend team meetings to exchange best practices and suggest improvements for audit vulnerabilities.

• Assist the Medical Director in ensuring accurate assessments of improper payments.

• Evaluate customer, provider, and stakeholder feedback, including issues, complaints, and accolades.

• Track performance metrics and recommend corrective actions or remediation strategies.

• Educate audit team members on findings from the Quality Team.

• Assess the performance of instructors and the effectiveness of training programs.

• Organize or facilitate continuous technical training and personal development sessions.

• Conduct healthcare audits and quality assurance reviews using clinical standards and coding knowledge.

• Analyze medical records to ascertain medical necessity, appropriateness of setting, billing/coding discrepancies, and quality issues.

• Interpret complex contract specifications and determine whether to approve or refer to the Medical Director.

• Provide feedback on reviews to the Quality Assurance Manager.

• Develop conceptual solutions, decision trees, strategies, and technological enhancements.

• Collaborate with Data Services to generate new reporting tools.

• Maintain productivity objectives and uphold audit quality standards, including hit rates, claims processed, and IDs per hour.

• Conduct QA audits against established quality and quantity benchmarks.

⛳️ Requirements

• An Associate’s Degree or equivalent relevant experience is required.

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

• 5–7 years of relevant experience, or 5–7+ years engaged with medical claims, billing/payment systems, provider billing protocols, payer reimbursement policies, medical necessity standards, and coding terminology.

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

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

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

• Background in home health, IRF, and SNF settings.

• In-depth knowledge of CPT and HCPCS coding systems.

• Compliance with official coding standards, coding clinic determinations, and CMS along with other regulatory compliance guidelines and mandates.

• Strong presentation skills and the capability to articulate and defend audit rationale to clients and key stakeholders.

• Familiarity with curriculum and training design, teaching methodologies for individuals and groups, and evaluation of training outcomes.

• Strong organizational and administrative skills; ability to manage multiple tasks, prioritize effectively, and meet deadlines.

• Proficient in audit technology such as R3 and CAT.

• Competent in Microsoft Word, Access, Excel, PowerPoint, and other relevant applications.

• Exceptional written and verbal communication abilities.

• Capacity to provide a dedicated, secure workspace with high-speed internet access/connectivity and an appropriate office setup.

• Capability to communicate effectively, solve problems, think critically, complete tasks independently, remain stationary for extended periods, and perform repetitive wrist, hand, and finger motions.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

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

• Discretionary bonus eligibility.

• Provision of a dedicated, secure workspace with high-speed internet access/connectivity as part of work conditions.