Team Lead, Senior Auditor – CCV

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

📋 Description

• Oversee a group of Clinical Validation Auditors or other members of the audit team.

• Manage workflow, distribute tasks, plan audits, and evaluate team performance.

• Ensure audits adhere to productivity benchmarks, quality standards, client SLAs, and clinical validation criteria.

• Enhance both individual and team efficiency, precision, and quality of deliverables.

• Train, onboard, coach, mentor, evaluate, and retain audit personnel.

• Act as the primary resource for questions related to claims and clinical industry standards.

• Collaborate with Quality Assurance, the Audit Manager, and Human Resources regarding performance management and employee relations.

• Develop and execute remediation strategies and process enhancements.

• Coordinate the hiring and retention of exceptional talent.

• Identify system issues for IT escalation and monitor and report downtime.

• Allocate work strategically to ensure timely task completion and optimized outcomes.

• Utilize data and analytical methods to track client performance and address outliers.

• Provide metrics such as hours worked, members reviewed, calls made, claims processed, and funds recovered.

• Address provider and client feedback and concerns, offering solutions as necessary.

• Fulfill performance review responsibilities, undertake special projects, and complete other assigned tasks.

⛳️ Requirements

• Associate or Bachelor's degree in nursing.

• Active and unrestricted RN license in the state of residence.

• 5+ years of relevant experience in auditing, quality, or appeals focusing on Place of Service, Short Stay, and Readmission audits.

• 2+ years of prior management or supervisory experience is preferred.

• Case Management Certification is preferred.

• Coding or Clinical Documentation Certification is preferred.

• Proficiency in computer applications such as Microsoft Excel, Access, and system databases.

• Previous experience in healthcare billing and/or claims is desired, but not mandatory.

• Capability to mentor staff and improve audit quality and productivity.

• Familiarity with relevant industry standards.

• Exceptional verbal and written communication skills.

• Ability to work independently as well as collaboratively within a team.

• Access to high-speed internet connectivity and an appropriate office setup and maintenance.

• A dedicated and secure workspace is required.

• Ability to remain stationary, frequently standing or sitting for extended periods.

• Ability to perform repetitive motions involving the wrists, hands, and/or fingers.

• Competence in communicating, problem-solving, interpreting data, making prompt workflow decisions, maintaining focus, assessing accuracy and thoroughness, learning new tasks, meeting productivity targets, and following protocols.

🏝️ Benefits

• Discretionary bonus eligibility.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

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