Analyst Quality Assurance Job in Cotiviti

Key Responsibilities

Generate and Develop New Audit Concepts

Utilizes retail and auditing experience to perform audit procedures that include analyzing, identifying and defining issues, developing criteria, reviewing and analyzing evidence with the intent to audit standard medium - complex reports. Leader in concept development across multiple audit verticals. This includes evaluating and specifying the concept, interacting with the client to test and gain acceptance. Will execute on the expansion of the concept based on customer requirements. Focused on growing concept approval.

Develops New Tools and Processes

Collaborates with Business Optimization and audit team in developing new tools and reports. Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction.

Meet or Exceed Standards for Quality

Achieve the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.

Direct Ownership for Quality Control

Reviews all level auditor claims prior to and after client submission. Set by the audit: for the auditing concept, audit against the expected level of quality and quantity (i.e. fees per hour, vendor/project volume completion, claims written). Makes decisions on audit work completed after the various possibilities have been considered.

Meet or Exceed Standards/Guidelines for Productivity

In addition to regular and predictable attendance, maintain production goals and quality standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity (i.e. fees per hour, vendor/project volume completion, claims written).

Prepare Response to Client Disputes

Provide oversight to audit team for verification of claims validation in concise written or oral manner. Makes determinations based on advanced experience of client knowledge of contract terms and likelihood of acceptance recovery.

Review Client Transactions

Demonstrates high level of expertise in reviewing transaction types, client contracts/vendor agreements, and client data with minimal supervision of how to identify potential over/under payments. Ability to serve as a Subject Matter Expert in a specific claim and/or business type. Participate in knowledge sharing with audit, region, & division.

Subject Matter Expert. Validate New Claim Types

With proficiency, utilize audit tools to evaluate, document and validate, to audit and client, new claims and concept effectiveness. Ensure that any new and existing concepts are achieving desired goals in terms of recoveries, collectability and client acceptance.

Auditor Development

Key participant in the development of audit staff. Actively trains audit team to execute basic, intermediate and complex audit projects with focus on new and existing audit concepts. May participate in auditor assessment, progression process, and staffing functions.

QA Claim Association/Concepts

Responsible for performing quality control process. Makes determinations based on advanced expertise and comprehension (knowledge) of claim categories and claim types. Ensures submission and execution of quality work, proper use of available proprietary

software, reports and IT resources to conduct audits.

Critical Success Factors

Lives Our Values

Understands and consistently demonstrates the spirit and behaviors associated with Cotiviti's values.

Professional Skepticism

A high performing audit requires the exercise of professional judgment by the auditor and importantly, a mindset that includes professional skepticism throughout the planning and performance of the audit. The need for professional skepticism in an audit cannot be overemphasized. Professional skepticism is an essential attitude that enhances the auditor's ability to identify and respond to conditions that may indicate possible misstatement, overpayment, underpayment or other anomaly. It includes a critical assessment of claims and other audit evidence. It also means being alert for audit evidence that contradicts other audit evidence or that brings into question the correctness of the information. This critical assessment is necessary in order for the Sr. Auditor to draw appropriate conclusions.

Critical Thinker

Demonstrates adeptness in developing new concepts that result in valid claims. Has an eye for irregularities. Ability to analyze data, identify inconsistencies and formulate workable solutions. Demonstrates logical well-reasoned and timely decisions regarding his/her portfolio of work assignments.

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 solve problems instead of waiting for someone else to solve them. Successfully integrates and multi-tasks new assignments.

Technically Capable

Demonstrated 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. Demonstrates expertise and ability to master systems and applications including

Decipher, Retriever and all systems needed for business segment.

Customer Centric

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.

Deliver Results

Produces and documents well written claims, consistent with Cotiviti's high level of integrity. Claims can be easily understood by client and provider/supplier community. Consistently meets or exceeds goals at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.

Time Management

Ensures timely completion of audit reports. Exhibit's an understanding of audit planning activities and uses a structured and dependable approach to accomplishing assigned work.

Continuous Improvement

Identify opportunities to improve the efficiency of standard reporting to reduce false positives, streamline the research process and strive to increase the fees per hour. Frequently offers constructive, unsolicited suggestions and recommendations for process improvement and efficiencies. Actively conceptualizes new reports and or root cause solutions.

Regulatory/Compliance

Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Assures confidentiality and security of all data. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.

E

Education

Degree Program of Study Required/Preferred

Bachelors Other Required

Educational Requirements

Bachelor's degree (B.A.) from four-year college or university

Certifications & Licensures

Certifications/Licensures Required/Preferred

Skills and Experience

Experience Requirements

Prefer 3-5+ years of Senior Auditor experience in an office environment from competitors or experience in financial institute or retail segment.

Excellent verbal and written communication skills required.

Advanced computer skills in Excel and Access required.

Experience in accounting, finance, accounts payable, merchandising, buying, or audit preferred.

Strong working knowledge and understanding of retail industries preferred.

Ability to successfully manage a team and collaborate with others.

Solid financial acumen and understanding of budget, forecast and workforce planning required.

Experience as a Quality Analyst is preferred

Any certification in Six Sigma will be considered as an added advantage

Disclaimer

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Employee Statement of Understanding

I have read and understand the job description for my position. I can perform all the essential functions of this position.

I agree to comply with the corporate compliance policy and all laws, rules, regulations and standards of conduct relating to my position. As an employee, I understand my duty to report any suspected violations of the law or the standards of conduct to my immediate supervisor.

As an employee, I will strive to uphold the mission and vision of the organization. All employees are required to adhere to the values in all their interactions with patients, customers, and fellow employees.