Cotiviti - Manager - Post Pay Audit Operations

Summary:

The Manager - Post Pay Audit is responsible for leading and optimizing post-payment audit operations, ensuring strategic alignment with Cotiviti's business objectives. This role oversees multiple teams, drives operational excellence, and ensures compliance with industry regulations. The Manager plays a crucial role in improving audit efficiency, developing high-performing teams, managing client relationships, and implementing process enhancements to maximize claim recovery and audit accuracy.

Key Responsibilities:

Strategic Oversight:

- Develop and execute strategic audit plans to drive efficiency, accuracy, and revenue growth.

- Oversee multiple audit teams and projects, ensuring alignment with business objectives.

- Ensure scalability and adaptability of audit processes to accommodate changing industry trends and regulations.

Operational Excellence:

- Oversee and manage day-to-day operational activities, ensuring adherence to established policies, procedures, and quality standards.

- Leverage data-driven insights to make informed decisions and implement best practices that drive operational excellence.

Process Optimization & Innovation:

- Identify gaps in audit methodologies and implement data-driven process improvements.

- Identify gaps in audit methodologies and implement data-driven process improvements.

- Drive continuous improvement projects to enhance audit recovery rates and reduce operational inefficiencies.

- Leverage analytics and reporting tools to track trends and optimize decision-making.

Financial & Performance Management:

- Develop and manage audit budgets, ensuring cost-effective operational execution.

- Drive key performance metrics such as audit efficiency, recovery success rate, and accuracy.

- Monitor financial performance and align audit strategies to maximize profitability and ROI.

- Identify new revenue opportunities within audit operations and contribute to business expansion initiatives.

Leadership:

- Provide strong leadership to the team, setting clear expectations and fostering a results-driven culture.

- Mentor, coach, and develop team members to enhance their capabilities, ensuring professional growth and career progression.

- Drive succession planning and career development initiatives within the audit function.

Stakeholder Management & Communication:

- Serve as the primary point of contact for senior stakeholders, clients, and leadership teams.

- Provide in-depth audit performance reports, insights, and recommendations to senior management.

- Lead client discussions, addressing concerns and presenting data-driven solutions to optimize claim recovery.

- Establish strong relationships with internal and external stakeholders to drive collaboration and business success.

Strategic Planning & Execution:

- Assist in developing and executing strategic initiatives to achieve departmental and organizational goals.

- Align team objectives with broader business strategies, ensuring seamless execution of initiatives. Contribute to risk assessment, business continuity planning, and process automation efforts.

Performance Monitoring & Reporting:

- Develop and maintain robust reporting frameworks to track operational performance, productivity, and efficiency.

- Generate detailed reports, dashboards, and presentations for senior management, providing actionable insights.

- Ensure accurate documentation of processes, performance metrics, and compliance-related activities.

- Utilize data analytics tools to track trends, forecast challenges, and recommend strategic improvements.

Drive Team Engagement:

- Drive team engagement, motivation, and professional development through structured coaching and leadership initiatives.

- Empower team members with skills to improve their confidence, product knowledge, and communication skills.

Data Analysis:

- Utilize internal tools and databases to assess claim accuracy and detect patterns of incorrect billing.

- Utilize data analytics tools to detect payment trends, anomalies, and fraud indicators.

- Develop and refine audit methodologies to improve accuracy and efficiency. Assist in process improvement initiatives by identifying workflow enhancements.

Quality Control:

- Work closely with quality audit teams to identify trends, errors, and areas for improvement.

- Enforce compliance with payer policies, regulatory guidelines, and internal audit standards.

People Management:

- Maintain efficient workflow by holding direct reports accountable for the quality and efficiency of their work.

- Build and maintain positive internal working relationships with all department employees by communicating in a professional manner.

- Provides visual and verbal support to the team by remaining accessible.

Performance Management:

- Provide guidance and effectively coach employees to achieve desired results and overall performance, encourage discussions to achieve long-term growth.

- Ensure all direct reports execute objectives using a developmental plan/ninety (90) day plan and regular performance reviews, posting productivity, quality and deadline results.

- Maintain consistency in applying company and departmental policy decisions by accurately and timely documenting employee files, including attendance, performance information, documented warnings, time off requests, coaching information, training information.

Performance Review:

- Conduct regular performance reviews, coaching sessions, and feedback discussions to drive individual and team development.

- Provide informal feedback on an ongoing basis and formal feedback in the annual performance evaluation process to identify and develop talent.

Hiring & Disciplinary Actions:

- Manage staffing through the appropriate hiring and disciplinary actions in collaboration with HR.

Critical Thinker:

- Demonstrates adeptness in identifying errors and exceptions that result in valid claims. Has an eye for irregularities.

- Ability to analyze data, identify inconsistencies and formulate workable solutions. Makes logical, well-reasoned and timely decisions.

Initiative Taker:

- Shows initiative and a willingness to engage in all areas of the audit. Reaches beyond current tasks to add value to audit team. Goes the extra step to solving problems instead of waiting for someone else to solve them.

- Successfully integrates and multi-tasks new assignments.

Technically Capable:

- Demonstrates competency with tools of the job including but not limited to computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, and data file structures.

- Can efficiently download and format common file types.

Delivers Results:

- Delivers results consistently with high level of integrity.

- Meets or exceed goals at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.

Relevant Experience and Educational Requirements:

- At least 10 years of relevant experience (auditing, claims, billing, reimbursement, data analysis).

- Candidate with US healthcare experience preferred.

- Management experience (Supervisor level or Higher)

- Must have ability to positively handle/manage stress, such as high work volume and frequent change.

- Excellent analytical skills with ability to troubleshoot problems and find root causes.

- Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred.

- Strong interest in working with large data sets and various databases.

- Healthcare industry experiences desired.

Skills and Competencies:

- A solid understanding of data crunching and excel.

- Strong analytical, critical thinking and problem-solving skills.

- Must be detail-oriented and flexible to work in a fast-paced, dynamic environment.

- Excellent verbal and written communication skills.

- Excel proficiency, Access proficiency will be an added advantage.

- Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads.

- Ability to work well independently and maintain focus on a topic for prolonged periods of time.

- Exhibits good listening skills and can accurately capture and implement requests.

- Ability to collaborate with teams on projects involving the onshore team.

- Ability to think "out of the box".

- Professional with ability to handle confidential information.

- Ability to handle multiple tasks, prioritize and meet deadlines.

- Comfort in working with team members that are remote and located in the US, India or other geographies.

- Ability to work within a matrix organization.

- Self-motivated and driven to succeed.

Job Demands:

- Review team performance based on historical data and quality scores generated by MIS and QA department.

- Active involvement in client communication to discuss feedback on agent performance weekly staffing and shift roster.

- Liaison between support function and operations to ensure smooth functioning of day-to-day activities.

- Responsible for data management in terms of dashboards and sending reports to clients.

- Keep a tab on login hours, productive time and ensure adherence to the standards by the client.

- Organize continuous feedback sessions for teams to sensitize them to important quality parameters.

- Review quality scores monthly and allocate agents in a PIP (Performance Improvement Plan) if required.

- Manage Client/onshore team interactions as and when required.

- Occasional requirement to travel (primarily related to training and Company meetings) within India or US.

- Ability to work seated at a computer for long periods of time.

- Candidate should be ready to work in different shifts, including night shift.

- Willing to work from office all five days of the week.