Team Lead - Appeals (Place of Service, Short Stay and Readmi

COTIVITI, INC.

SOUTH JORDAN, UT

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JOB DETAILS

SKILLS

Auditing, Best Practices, Budgeting, Clinical Practices/Protocols, Clinical Validation, Coaching, Cost Control, Customer/Client Research, Data Analysis, Employee Relations, Employee Retention, Healthcare, Human Resources, Industry Standards, Information Technology & Information Systems, Maintain Compliance, Mentoring, Metrics, Nursing, Onboarding, Performance Analysis, Performance Goal Setting, Performance Management, Performance Reviews, Performance Tuning/Optimization, Process Improvement, Process Management, Productivity Management, Quality Assurance, Reporting Skills, Resource Leveling, Service Level Agreement (SLA), Team Lead/Manager, Time Management

LOCATION

SOUTH JORDAN, UT

POSTED

17 days ago

Team Lead - Appeals (Place of Service, Short Stay and Readmission) Job Locations US-Remote ID 2026-18265 Category Audit - Healthcare Position Type Full-Time Overview This is a Senior Auditor, Team Lead, with responsibility for supervising a team of Clinical Validation Auditors or other audit team members. Team Leaders ensure that the work of others meets productivity standards, quality guidelines and audit efforts of the client engagement. Primary responsibilities include queue management, work distribution, performance and production optimization, audit planning, auditor interactions, training of new hires/existing staff, Audit Report and Claims writing and support of audit closure activities. The Senior Auditor goal is to ensure the team audits client data on behalf of our clients, generating high quality recoverable claims. Displays professional skepticism that enhances the work performed in order to achieve success in position. This Team Lead role is aligned with our Appeals team and the majority of the work/team are Sr. Auditors focused on Place of Service, Short Stay and Readmission appeals. Ideal candidates will have a nursing degree and a background in Auditing, Quality or Appeals focused on these types of audits: Place of Service, Short Stay and Readmission. Responsibilities Oversees audit team responsible for producing quality audit outcomes and well written sustainable findings. * Provides support to the audit team to ensure outcomes are based on nationally recognized standards and proprietary clinical validation guidelines. Monitors the flow of claims ensuring adherence to client SLA's. * Primarily responsible for optimization of team and individual auditor performance including production, accuracy and quality deliverables. * Responsible for handling the training and process improvements working in conjunction with the team; work with Quality Assurance to ensure auditors are meeting accuracy and quality execution of audit deliverables. Develops and implements remediation efforts when warranted. * Handles employee reviews, new hire on- boarding, PTO, coaching and mentoring; monitors staff productivity. * Serves as first level resource for the Clinical Validation auditors in terms of questions related to specific claims and clinical industry standards. Creates an environment that fosters information sharing. * Collaborates with Manager and Human Resources in applying best practices to areas of Employee Relations and performance management. Ensures all Cotiviti and department rules and processes are followed. Assist and coordinate with manager to hire and retain top talent. * Actively recommends system or process improvements or enhancements that will increase productivity, quality or cost containment. * Capture system issues for IT escalation, track and report downtime. * Ensures operational controls and day-to-day processes are in place to meet client budget goals. Strategically distributes work among Auditors - ensuring timely completion and optimized results. * Uses data and analytic techniques to monitor client performance to identify and remediate outliers. * Provides metrics and information, as requested or scheduled, to include (but not limited to): hours worked, members reviewed, calls made, claims written, and dollars found. * Elevates provider/client suggestions and concerns to appropriate Audit Manager, and offer solutions as needed. * Ensures alignment between strategic goal setting process and performance management process to ensure the organization has the depth and breadth of talent to achieve organizational goals. * Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is... For full info follow application link. Equal Opportunity Employer/Protected Veterans/Individuals w th Disabilities

About the Company

COTIVITI, INC.

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