DRG Clinical Validation Audit (CVA) Manager

EXL Health is looking for a DRG Clinical Validation Audit (CVA) Manager. This is 100% remote work from home opportunity!

Are you an experienced Payment Integrity leader looking for the next step in your career path?  Is it time for a change?  Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this role you will collaborate with a diverse group of Payment Integrity Audit Program leaders, and our operational team members to manage the day-to-day operations to ensure timely completion of each step of the complex audit process from selection to recovery. The successful candidate will be passionate, quality focused and have a diverse clinical background and a background in clinical audit. 

The successful candidate will manage a team of CVA auditors, collaborate with other areas to identify and work on resolution for areas of potential risk or concern that impede optimal recovery results. Passionate about Payment Integrity, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.

Job Responsibilities:

• Support work environment to facilitate employee satisfaction, people development, continuous process improvement, quality, productivity, and client satisfaction.
• Monitor Key Performance Indicators to ensure auditor productivity requirements are being met
• Collaborate with DRG SME and Appeals Auditors to continue to refine and develop the concepts and potential training.
• Assist with auditor questions and day to day process questions
• Lead provider/client peer-to-peer discussions and respond to inquiries regarding audit results, program guidelines, dispute responses, and other general clinical questions
• Identify and assist with implementing process enhancements that optimize recovery opportunities
• Inventory management for the CVA program to ensure audits compliant with regulatory timeframes.
• Work with team members to solve problems with aging inventory or other operational issues
• Assist with creating and maintaining Statement of Policy (SOP) to ensure compliance with client Statement of Work
• Ensure compliance with internal policies and procedures, external regulations, and information security standards
• Assist with hiring, on-boarding, and training as appropriate for new employees
• Capable of building and maintaining strong interdepartmental working relationships
• Support operational projects and activities to drive process improvement which may include participation in technical/business discovery conversations, completion of root cause analysis to identify and solve for operational challenges/barriers to program success

Qualifications:

• 5+ years of experience Payment Integrity Complex Audit & Recovery programs preferred
• CVA expert with in-depth knowledge of complex reimbursement methodologies
• 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 or CPC preferred.

Work Experience Requirements:

• Strong leadership and organizational skills, with the ability to develop work plans, action plans, and standard operating procedures
• MS-DRG and APR DRG experience
• Advanced Excel skills preferred
• Proficient with Microsoft Word & Power Point

What We Offer: 

• EXL Health offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.