Senior Manager, Audit Operations; CCV

Overview

The Sr. Manager, Audit Operations is responsible for leading the Clinical Chart Validation (CCV) audit operation, managing the audit team’s performance and productivity, ensuring client SLA’s and budget commitments are achieved, claim workflow is uninterrupted, and talent management is prioritized. This particular Sr. Manager role has expanded process improvement responsibilities across the CCV Audit including vendor management, NLP program oversight and serves as the lead on other process improvement initiatives designed to optimize team efficiency through automation and other means.

This role will have 4-6 direct reports and up to 90 indirect reports.

• Accountable for overseeing process improvement strategic initiatives that primarily lead to measurable audit efficiencies and cost savings; with associated increased revenue.
• Works closely with Audit Leadership colleagues and personnel to continuously identify improvement opportunities, formulate improvement plans, and facilitate the execution of such plans.
• Oversees the Natural Language Processing program ensuring value is optimized through NLP rule and UI optimization, auditor proficiency with the tool, and vendor collaboration.
• Leads vendor management oversight and serves as the contractual liaison for software support.
• Provides day‑to‑day supervision and direction to assigned audit Team Leads. Ensures operations are running optimally and processes and procedures are being followed.
• Ensures appropriate staffing levels and plans and organizes workloads and staff assignments according to the needs of the audit. Manages the overall performance, productivity, and quality of the assigned audit teams. Maximizes opportunities of the audit; optimizes timely audit processes and efficiencies.
• Involved in formulating all budget related aspects of the audit. Executes and adjusts to budget demands. Drives the profitability of the audit engagement.
• Consistent with good people management practices and company values, providing managerial leadership and directing the selection, supervision, evaluation, and development of staff. Set objectives and conduct performance reviews for direct reports and oversee the remaining evaluations for indirect team members.
• Work with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolve employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines.
• Follow established processes for training and career progression to enable revenue growth and auditor and support staff development and engagement. Promote & participate in knowledge sharing activities such as best practices, benchmarking, whitepapers, and IT tools enhancement. Ensure that all levels of staff are properly trained on policies, procedures and best practices and that proper training, education and required certifications are maintained as required.
• Innate ability to share knowledge and develop audit skills in others. Broadly fosters formal and informal knowledge sharing activities.
• Assigns proportionate workload to team that yields maximum productivity and achievable, profitable results.
• Always goes over and above what is expected in seeking and sharing ideas in a positive and productive way. Considered go to person for root cause process improvements. Capitalizes on audit resources to extend current or business capabilities, ensuring that client demands are met in the short and long term.
• Treats customers/clients both internal and external as number one priority, is committed to continuous quality improvement, is courteous and responsive to customer's needs, meets or exceeds all customer commitments and treats customers honestly.
• Direct accountability for overall Quality Control Process within the audit. Demonstrates advanced expertise and comprehension (knowledge) of claim categories, claim types. Holds the Audit team accountable for ensuring submission and execution of quality work, proper use of available proprietary software, reports, and IT resources to conduct audits.
• Demonstrates understanding of Cotiviti policies & procedures…