Clinical Validation Audit Manager
Experience: Job Code: REQ-019316
Sagility
Work@Home USA
job Details
Job title
Clinical Validation Audit Manager
About Sagility
Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
Job Description:
The Sagility team is currently hiring a talented Clinical Validation Audit Manager. In this role you will be responsible for the following areas:
· Foster a positive and productive work environment that promotes employee engagement, professional growth, continuous improvement, quality, efficiency, and client satisfaction.
· Track and evaluate Key Performance Indicators (KPIs) to ensure auditors meet established productivity benchmarks.
· Partner with DRG Subject Matter Experts and Appeals Auditors to enhance training materials and refine key concepts.
· Provide guidance and support on auditor-related inquiries and routine process questions.
· Facilitate provider and client peer-to-peer discussions, addressing questions related to audit findings, program protocols, dispute responses, and general clinical matters.
· Identify opportunities for process improvements and support the implementation of strategies that enhance recovery outcomes.
· Oversee inventory management for the CVA program to maintain audit compliance with regulatory deadlines.
· Collaborate with team members to resolve issues related to aging inventory and other operational challenges.
· Contribute to the development and upkeep of Standard Operating Procedures (SOPs) to align with client Statement of Work requirements.
· Ensure adherence to organizational policies, external regulatory standards, and data security protocols.
· Support recruitment, onboarding, and training efforts for new team members as needed.
· Build and sustain strong cross-functional relationships across departments to improve collaboration and workflow.
· Participate in operational projects focused on process optimization, including technical/business discussions and root cause analyses to address barriers to program success.
Qualifications:
5+ years of experience Payment Integrity Complex Audit & Recovery programs
CVA expert with in-depth knowledge of complex reimbursement methodologies
MS-DRG and APR DRG experience
Experienced remote team manager for a diverse group of audit professionals
Strong organizational, project management, and analytical skills, with attention to detail
Excellent oral and written communication skills
Education and Required Certification:
Current unrestricted nursing license, RN
RHIT, CCS, CIC or CPC preferred.
Location: