Clinical Validation Audit Manager

Job title
Clinical Validation Audit Manager

About Sagility

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 ...