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: Clinical Validation Audit Manager 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: Work@Home USAUnited States of America 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.
