Manager Audit Content (CCV)

Overview:

The Manager, Audit Content position is responsible for leading a team of Concept Development Analysts (CDA) and Operations Administrators in delivering value to Cotiviti’s operations and clients. This leader is responsible for oversight of their team, as well as participating in the development of new and existing complex audit concepts, executing audit projects, and updating concept policies based on changes in clinical and coding developments, statutes, regulations, and client policies.

The Manager, Audit Content, guides their team in the identification, development, and implementation of new concepts based on industry experience and a strong knowledge of regulatory requirements. This role conducts and documents complex projects and mentors less senior team members in project completion. The Manager, Audit Content uses subject matter expertise and experience to lead their team in successfully investigating and identifying issues, trends in concept performance and selections, and the maximization of audit opportunity. This role acts as a subject matter expert in concept development and selections for all Cotiviti Content Validation (CCV) business partners.

• Leadership and Team Development:
• Provide leadership to the team by communicating all expectations and ensuring alignment with Cotiviti’s long-term objectives.
• Motivate employees through individual, team, and department recognition.
• Recruit and hire new staff, manage existing staff, and develop and implement training and orientation programs that ensure consistency and accuracy.
• Ensure goals and standards are consistently met, removing roadblocks to exceptional performance.
• Monitor team coverage of responsibilities and ensure accountability.
• Strategic Contributions:
• Lead all efforts with new products, collaborating with Product Managers to ensure success.
• Implement CCV initiatives such as PCCV, selection tool integrations, CCCR, and AI model management.
• Partner with AI and machine learning teams to align long-term plans with ACV goals.
• Optimize business tools, including DCS, CCS, Tableau, Cube, QTS/CA, Ops AI, Operational Intelligence, and Power-automate, to support innovation and optimize coding-based content.
• Build collaboration opportunities across government and commercial teams, including offshore teams like Operational Insights and the Research Team.
• Innovation and Process Optimization:
• Foster an environment of innovation, such as Tableau reporting reforms and process efficiencies.
• Document and enforce standard operating procedures
• Develop a deep understanding of Spark DCS systems and their integration with PCCV and CAT/CCS.
• Coordinate reference table management, whitepaper training, Q6 portal upgrades, and research maintenance.
• Partner with content leaders as the business lead overseeing products, tools, and teams servicing CCV, including AI/Model, HIBIS, Product, Operational Insights, and selection reference table management.
• Subject Matter Expertise:
• Provide expertise regarding reimbursement methodologies and applicable regulations.
• Remain abreast of industry and client trends, anticipating impacts to the team and regulatory changes.
• Use experience and analytics knowledge to identify concept effectiveness and opportunities for refinement.
• Act as a subject matter expert for concept development and selections across all Cotiviti business partners.
• Collaboration and Relationship Management:
• Ensure an optimized relationship between the DIS team.
• Coordinate with Exclusions and Selections Operations (ESO), Client Services, and Operations management to troubleshoot and resolve client concerns.
• Lead on complex outpatient tasks, APC execution, and VA contract expansions.
• Talent Management:
• Hire, develop, coach, and retain top-tier talent with a focus on building and maintaining a best-in-class team culture.
• Enhance employee development through mentorship opportunities, tailored development plans, and recognition programs like quarterly awards and peer-nominated recognitions.
• Coordinates activities with the Exclusions and Selections Operations (ESO) team, Client Services team, MD team and Operations management to troubleshoot and resolve client concerns.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that can assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction. Required

• Complete all responsibilities as outlined in the annual performance review and/or goal setting. Required
• Complete all special projects and other duties as assigned. Required
• Must be able to perform duties with or without reasonable accommodation. Required

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Required

• Bachelor’s degree in Nursing, Health Information Management (HIM), or a related field required.
• State licensure or AHIMA/AAPC coding certification (CPC, CPC-H, or CCS) required.
• Emphasis in technology/informatics preferred, with extensive knowledge of medical procedures, conditions, illnesses, and treatment practices.
• A minimum of 8 years of related experience in healthcare, with proven expertise in Hospital, Home Health, Hospice, DME, SNF, or Physician Billing.
• Minimum of 3 years of medical record auditing experience, preferably at Cotiviti or a similar payment integrity company.
• Previous management experience required.
• Proficient in Microsoft Word, Excel (including Pivot tables), Access, and Outlook.
• Advanced proficiency with healthcare coding systems (CPT4, HCPCS, DRG, ICD-9, ICD-10, Modifiers, Revenue Codes, etc.).
• Familiarity with Medicare reimbursement methodologies, billing guidelines, and claim adjudication standards.
• Demonstrated ability to perform critical thinking and problem-solving with strong multi-tasking capabilities.
• Self-motivated to exceed service goals for quality, timeliness, and efficiency.
• Exceptional written and verbal communication skills with the ability to mentor and teach.
• Strong leadership and team-building abilities, with a focus on fostering a culture of collaboration and high performance.
• Expertise in leveraging AI tools and other emerging technologies to optimize operations and enhance productivity.

Mental Requirements: 

• Strong presentation and customer (internal/external) engagement skills.
• Strategic thinker with ability to identify novel product opportunities and problem-solving and implementation skills to operationalize them.
• Strong project management, interpersonal, communication, negotiation and problem-solving skills.

Physical Requirements and Working Conditions: 

• Remaining in a stationary position, often standing or sitting for prolonged periods. 
• Repeating motions that may include the wrists, hands and/or fingers.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $110,000 to $138,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 2/7/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 4/7/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-Remote

#LI-JJ1

#Senior