Auditor Technical Trainer (Outpatient/Specialty Audits) Job Locations

US-Remote ID

2024-13257

Category Audit - Healthcare  

Position Type Full-Time Overview

This role is part of the training team for the Clinical Chart Validation team. This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment. The individual will work collaboratively with subject matter experts in the Commercial and Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.

Responsibilities

Training, Development, and Mentoring. Assess job-specific needs and develop technical training plans with clear business objectives, including working with subject matter experts, developing training materials, and developing appropriate assessments and measurements of success. * Select training/instructional methods and procedures appropriate for the situation when learning or teaching new skills. * Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar.  Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills. * Provide support to the CCV audit team members; assist with orientation of new members as needed, mentor new team members after orientation. * Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings. * Encourage critical thinking and discussion among team members on concepts as needed. * Provide training on one or more of the following audit types: DRG and Clinical Validation, Short Stay, to include Milliman, InterQual, Readmissions, Outpatient and Specialty Review Types. * Train Clinicians with coding certifications on coding principles. * Confer with management, and conducts surveys to identify training needs based on projected production processes, changes, and other factors. * Participate in weekly/monthly team meetings to share best practices initiatives and recommend audit vulnerabilities. * Support the Medical Director to ensure accurate assessments of improper payments are based on consistent application of clinical guidelines. Assess customer/provider/stakeholder issues, complaints, and compliments. * Monitor/Assess performance of self, other individuals, and/or organizations to make improvements or recommend remediation or corrective action. * Work with the Quality Team to train audit team members on findings from quality review audits. * Develop testing and evaluation procedures.  Evaluate instructor performance and the effectiveness of training programs, providing recommendations for improvements.  Conduct or arrange for ongoing technical training and personal development classes for staff members. Quality Assurance Controls. * Integrate healthcare auditing principles and uses objectivity in the performance of medical audit activities and reviews. * Draw on healthcare proficiency and industry knowledge to substantiate conclusions. * Perform work independently, review and interprets audit work of others. * Depending on nature and scope of the audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns. * Demonstrate an understanding of complex contract specifications when performing medical record reviews. * Use healthcare expertise to determine approval or referral to the Medical Director. * Provide fe edback on... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities