Overview
As a member of the Recovery Quality Team within Yield Management, this team identifies the process for Quality Assurance on the recovery of funds for the client and maintains exceptional provider relations by building working relationships and partnerships with our internal Recovery teams of Workforce and Resolution. This department collaborates with other functions such like, Yield Management along with payers and providers to understand claims and/or concepts to ensure 100% quality is measurable and achieved on the team. This team will act as the liaison for International Operations and ensure all metrics are upheld accordingly to client, and government regulations.
The Quality Assurance team may work closely with Workforce within Recovery Operations to align on department gaps and recommend solutions for optimal business optimizations. As a Recovery Quality Assurance, Specialist, this role will work under the direct supervision of the Team Lead to ensure Quality Assurance metrics are upheld accurately within the Recovery Operations team. A Specialist may assist with coaching and training alongside the Senior and Team Lead to supply training tools and tips to the Recovery Resolution team.
Responsibilities
Monitors Recovery Resolution Specialists and Senior Recovery Resolution specialists for compliance and reports to management based on recorded telephone conversations and system notes between providers and Recovery Resolution specialists.
Completes evaluation scorecards based on recorded telephone conversations/system notes and/or applicable research functions.
Identifies common obstacles within the systems/teams and escalates to department managers.
Coordinates meetings with individual Recovery Resolution Specialist to discuss development opportunities from undesirable scores and identifies a performance plan of improvement required.
Coaches’ collectors on procedural changes and process updates and steps to navigate the collection call to achieve increased results and revenues.
Ensures contractual obligations regarding call monitoring are met.
Performs various quality audits and lead/assist with research initiative.
Provides accurate information, supporting documentation, and effective communication to improve the recovery process.
Documents details in the system. Utilizes with increasing proficiency, proprietary reports, tools, and systems required to perform duties.
Maintains productivity goals and standards set by the department. Ensures all department rules and processes are followed. Alerts manager of system issues or other issues impacting productivity.
Achieves the expected level of quality set by the department. Verifies completeness and accuracy of work. Alerts manager of issues or concerns impacting quality of work.
Quickly grasps a working understanding of basic elements and concepts of audit operations. Demonstrates enthusiasm for learning and applying knowledge to the completion of tasks. Successfully integrates and executes new assignments with moderate guidance and direction.
Demonstrates adeptness in gathering data, analyzing problems, evaluating options, and developing/implementing creative solutions to job challenges. Makes logical, well-reasoned and timely decisions, seeking guidance and support as appropriate.
Demonstrates ability to plan, organize, and prioritize multiple tasks and ensure timely completion. Uses a structured and dependable approach to accomplish work assignments.
Shows initiative and a willingness to engage in all audit support activities. Reaches beyond current tasks to add value to broader team. Goes the extra step to solve problems instead of waiting for someone else to solve them.
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, adhering to all HIPAA laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
Works with clients, customers, and partners to accurately assess their needs, provide information or assistance, resolve problems, or satisfy requirements.
Can be counted on to consistently meet or exceed goals and perform at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.
Qualifications
High School graduate or equivalent education.
0 – 2 year of related experience and/or 1 to 3+ years prior healthcare or collection experience preferred.
Requires working knowledge of and applicable industry-based standards.
Excellent verbal and written communication skills.
Ability to work well in an individual and team environment.
Must be detailed oriented and organized in recording and documented work products for the success of the department.
Ability to create and maintain collaborative partnerships.
Ability to perform note audit.
Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.
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Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Cotiviti values its diverse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)