Policy Quality Auditor I Job 2024 Full Time

Responsibilities:

• Validate the accuracy of new policies being implemented and existing policies for clients
• Ensure the capture and completion of project requests and processed work orders are validated accurately per policy; confirm corrections are made (if needed) by the desired completion date
• Generate all necessary reports for each project to validate accuracy
• Communicate effectively and timely with upstream functional areas to resolve issues
• Meet daily and monthly production and quality targets
• Maintain an exemplary level of accuracy in all work
• Actively monitoring queues to ensure all requests are executed per the allocated deadlines
• Thoroughly document all peer and audit findings through internal software tracking application as well as on the work orders
• Monitor Industry Update applications to ensure all audit is complete against appropriate decisions taken, successfully implemented, and documented accordingly
• Accurately assesses the impact, benefits, and risks associated with the best course of action and makes high quality and timely decisions
• Work closely with Policy Design, Configuration, and Integration teams to ensure timely response to client requests

Qualifications:

• High School diploma required
• Bachelor’s degree preferred or equivalent experience
• Prefer CPC (Certified Professional Coders), CCS, or RHIA certification

• 1 to 2 years Cotiviti experience or industry experience
• Knowledge of CPT-4, ICD-10-CM, HCPCS coding, and medical terminology
• Familiar with medical terminology and medical claim life cycle
• Knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Knowledgeable in creating, reviewing, and analyzing reports
• Excellent written and verbal communication skills
• Presents information and ideas in a thoughtful and compelling manner with individual SMEs (subject matter experts) or team to achieve results
• Able to learn and apply new material
• Adapt quickly and easily to the latest information, changing conditions or unexpected events
• Team player with an ardent desire to assist others and share information freely
• Self-starter, with strong confidence level to perform responsibilities independently
• Sets clear priorities, takes action, stays focused, and overcomes barriers to deliver expected results
• Evaluates critical information needed to understand problems, determine probable causes, and develops workable solutions
• Ensure the security of confidential and sensitive information
• Seeks to understand the perspective of others in a team environment
• Able to handle multiple tasks, prioritize and meet deadlines

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

• 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 a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.