Cohere Health is a Software-as-a-Service (SaaS) company focused on improving the patient journey by enhancing the quality of care at lower costs, as well as emp
Team Lead, Auditing
Location
United States
Posted
1 day ago
Salary
$100K - $110K / year
Seniority
Lead
No structured requirement data.
Job Description
Team Lead, Auditing
Cohere Health
Role Description We are seeking a Team Lead, Auditing to join our dynamic Payment Integrity team. This critical role involves leading a team of auditors (such as Inpatient, Outpatient, Professional) conducting comprehensive reviews to ensure the accuracy of claims and maximize overpayment identification. If you possess a CCS credential, a deep understanding of inpatient, outpatient and professional auditing, and a passion for deep analytical work, you will be instrumental in supporting Cohere Health’s commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment. What You'll Do: - Lead and mentor a team of auditors, managing workloads and supporting professional development. - Collaborate cross-functionally to align on production, quality review and meeting defined timelines. - Conduct comprehensive coding reviews to ensure accuracy and reimbursement. - Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. - Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. - Utilize advanced DRG encoder tools to drive efficiency and accuracy in audits. - Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. - Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. - Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. - Maintain and apply knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language. Qualifications - 8+ years experience of performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or Payer. - 2-3 years of supervisory/management experience, including supervising and training in a remote work environment. - CCS (Certified Coding Specialist) credential highly preferred. - RHIA, or RHIT credential, Associate's Degree in Health Information Management, Nursing, or related field preferred. - Preference for candidates holding both a coding credential and an HIM credential (RHIA/RHIT). - Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. - Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, ensuring recommendations reflect professional expertise. - Experience using CMS NCDs/LCDs and clinical criteria guidelines. - Self-motivated and able to work independently in a remote environment while maintaining high performance. - Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously. - Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning. - Excellent written and verbal communication skills, strong analytical skills, and attention to detail. - Inpatient audits experience for case rate and per diem. - Preference for candidates with outpatient and professional claims auditing experience. - Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability. - Familiarity with working with a diverse, global team of talent. - Excellent computer skills and familiarity with a Mac. Benefits - 💻 Fully remote opportunity with about 5% travel - 🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program - 📈 401K retirement plan with company match; flexible spending and health savings account - 🏝️ Time Off + company holidays - 👶 Up to 14 weeks of paid parental leave - 🐶 Pet insurance Interview Process - Connect with Talent Acquisition for a Preliminary Phone Screening - Meet your Hiring Manager! - Interview with Subject Matter Expert - Behavioral Interview
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