Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Director on our Payment Accuracy team.

The Director of Audit Operations is responsible for providing strategic direction, leadership, and management oversight for one or more audit function(s) within the organization. This role entails developing and implementing audit plans for assigned accounts to maximize valid claim identification and overpayment recoveries, meet contractual commitments, and deliver customer satisfaction consistent with established policies, procedures, and best

practices to ensure compliance with regulatory requirements and organizational objectives.

This will be accomplished through effective audit operations management, quality and service assurance, and effective people management and development. The Director leads a team of managers and/or team leads to accomplish identified goals and strategic results for each calendar year.

Strategic Planning:

• 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.
• Consistent with people management practices and company values. Provides managerial leadership and directs the selection, supervision, evaluation, and development of employees. Sets objectives and conducts performance reviews for direct reports and oversees the remaining evaluations of indirect team members.
• Follow established processes for training and career progression to enable revenue growth and employee development and engagement. Promotes & participates in knowledge-sharing activities such as best practices, benchmarking, and IT tools enhancement. Ensures that all levels of employees are properly trained on policies, procedures, and best practices and that proper training, education, and required certifications are maintained as required.
• Proactively plan for succession and growth; ensures no gap in productivity and customer service.
• Develop and execute a strategic audit plan aligned with the organization's goals and objectives.
• Collaborate with senior management to ensure alignment of audit priorities with business strategies.

Audit Management:

• Lead and provide guidance, mentorship, and support to ensure the effective performance of both individual contributors and people leaders to navigate budgeting and outline goals for each calendar year.
• Oversee the planning, execution, and reporting of internal audits, including financial, operational, and compliance audits.
• Ensure audits are conducted in accordance with established standards, policies, and procedures.
• Review audit information, findings, and recommendations to ensure accuracy, completeness, and relevance.
• Review progress against established metrics and direct activities as needed to ensure the achievement of business goals and customer expectations. Ensures effective coordination with Engineering and other support functions to achieve audit goals. Demonstrates awareness and sensitivity to the needs of the client, the needs of the audit team, and the profitability of the audit engagement.
• Create, maintain, and monitor quality standards for teams to adhere to fulfill contractual requirements and client satisfaction. Quality is inclusive of the quality of results as well as delivery of whitepapers, adhering to service letter agreements (SLA’s), etc.

Communication:

• Communicate audit findings, recommendations, and corrective actions to senior management and relevant stakeholders.
• Prepare and present audit reports and presentations to executive leadership, audit committees, and other governance bodies.
• Collaborate with stakeholders to address audit findings and implement remediation plans.
• Effectively manages customer problems and conflict, including direct communication with customers to achieve mutually accepted resolution. Assists and removes barriers as needed to identify opportunities for process improvements. Serves as a top escalation point to resolve any customer issues that are roadblocks to customer satisfaction. Partner on the implementation of all appropriate actions by other leaders and teams to understand and resolve issues and ensure following through until closure and complete customer satisfaction.
• Directs the successful delivery of audit services to the client by managing the team(s) assigned to the engagement providing leadership and direction and ensuring that the client's needs and expectations are met and exceeded. Develops and implements key metrics to drive performance in quality and productivity and to ensure that the customer experience is consistent and satisfactory across all phases of the audit.
• Support the Vice Presidents on renewals and work through any request for proposal (RFP) process by identifying gaps in the current contract in place and understanding customer needs to successfully renew the contract. Performs customer needs and service analysis, makes recommendations on appropriate pricing structure and contract requirements, and contributes to RFP responses.

Continuous Improvement:

• Identify opportunities for process improvement and efficiency gains within the audit function.
• Implement best practices and innovative approaches to enhance the effectiveness and efficiency of audit processes.
• Foster a culture of continuous learning and development within the audit teams.
• Supports the continuous development of innovative solutions and concepts across all possible claim categories and claim types utilizing all available proprietary software, business intelligence, reports, and engineering resources. Works to optimize audit processes and efficiencies.
• Continually work to improve efficiency, and productivity and reduce operational costs while providing 100% compliance with customer contracts and company policies

Partnership:

• An ability to effectively work with clients, customers, and partners to accurately assess needs, provide information or assistance, resolve problems, or satisfy requirements.
• Balances customer demands with sound business management and can effectively match resources to the job and execute to meet business needs.
• Understands the importance of teamwork and displays an ability to build and maintain positive and productive working relationships across a broad range of people and groups at all levels - both internally and externally. 
• Takes initiative in gathering information and incorporates this knowledge and information to ensure projects meet organizational goals.
• Open to change and new information, adapting behavior and work methods in response to new information, changing conditions, or unexpected obstacles.
• A willingness to champion new ideas and methods, despite opposition, when the organizational benefits outweigh the costs.
• Understands the roles, relationships and systems utilized amongst Sales, Operations, Finance, Engineering, and others, coupled with a desire to improve processes to the advantage of our customers and the organization.
• Makes sound, well informed, and objective decisions; perceives the impact and implications of these decisions; commits to action, even in uncertain situations, that support accomplishment of Organizational goals.
• Works with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolves employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines.

Risk Assessment and Mitigation:

• Conduct risk assessments to identify and evaluate potential risks to the organization.
• Develop risk-based audit plans and methodologies to address identified risks.
• Implement controls and mitigation strategies to minimize risks and enhance internal controls.

Regulatory Compliance:

• Stay abreast of regulatory requirements and industry standards related to auditing and internal controls.
• Ensure compliance with relevant laws, regulations, and standards in audit activities.
• Liaise with regulatory agencies and external auditors as necessary.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements.
• Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

• Bachelor’s degree with 8+ years of relevant experience or equivalent combination of education and work experience with healthcare payers.
• Demonstrated leadership abilities, including team management, coaching, and development.
• Knowledge of the healthcare payer marketplace, competitive landscape, financial acumen, and understanding of business drivers.
• Healthcare industry experience to "drill down" into highly technical, complex areas and operate effectively as an expert and resource both independently and collaboratively.
• In-depth knowledge of auditing standards, principles, and practices.
• Strong analytical and problem-solving skills, with the ability to interpret complex data and information.
• Excellent communication and interpersonal skills, with the ability to effectively engage with stakeholders at all levels.
• Ability to work independently, prioritize tasks, and meet deadlines in a dynamic environment.
• Proficiency in audit software, data analytics tools, and Microsoft Office Suite; Excel.
• Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Mental Requirements:

• Leadership, emotional intelligence, and empathy
• Stress Management.
• Ethical decision-making.
• Adaptability to multiple systems and platforms for operational success.
• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Interpreting and analyzing data.
• Maintaining focus.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.

Physical Requirements and Working Conditions:

• Occasional Travel as assigned by Senior Leadership (10 – 15%).
• Remaining professional and available for video calls for prolonged periods.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• No adverse environmental conditions are expected.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Base compensation ranges from $140,000 to $170,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

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: 8/23/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 9/23/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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