Team Lead - Appeals (Place of Service, Short Stay & Readmission)

Overview

This is a Senior Auditor, Team Lead, with responsibility for supervising a team of Clinical Validation Auditors or other audit team members. Team Leaders ensure that the work of others meets productivity standards, quality guidelines and audit efforts of the client engagement. Primary responsibilities include queue management, work distribution, performance and production optimization, audit planning, auditor interactions, training of new hires/existing staff, Audit Report and Claims writing and support of audit closure activities. The Senior Auditor goal is to ensure the team audits client data on behalf of our clients, generating high quality recoverable claims. Displays professional skepticism that enhances the work performed in order to achieve success in position.

 

This Team Lead role is aligned with our Appeals team and the majority of the work/team are Sr. Auditors focused on Place of Service, Short Stay & Readmission appeals.  Ideal candidates will have a nursing degree and a background in Auditing, Quality or Appeals focused on these types of audits: Place of Service, Short Stay & Readmission.  

Responsibilities

• Oversees audit team responsible for producing quality audit outcomes and well written sustainable findings.
• Provides support to the audit team to ensure outcomes are based on nationally recognized standards and proprietary clinical validation guidelines. Monitors the flow of claims ensuring adherence to client SLA’s.
• Primarily responsible for optimization of team and individual auditor performance including production, accuracy and quality deliverables.
• Responsible for handling the training and process improvements working in conjunction with the team; work with Quality Assurance to ensure auditors are meeting accuracy and quality execution of audit deliverables. Develops and implements remediation efforts when warranted.
• Handles employee reviews, new hire on- boarding, PTO, coaching and mentoring; monitors staff productivity.
• Serves as first level resource for the Clinical Validation auditors in terms of questions related to specific claims and clinical industry standards. Creates an environment that fosters information sharing.
• Collaborates with Manager and Human Resources in applying best practices to areas of Employee Relations and performance management. Ensures all Cotiviti and department rules and processes are followed. Assist and coordinate with manager to hire and retain top talent.
• Actively recommends system or process improvements or enhancements that will increase productivity, quality or cost containment.
• Capture system issues for IT escalation, track and report downtime.
• Ensures operational controls and day-to-day processes are in place to meet client budget goals. Strategically distributes work among Auditors - ensuring timely completion and optimized results.
• Uses data and analytic techniques to monitor client performance to identify and remediate outliers.
• Provides metrics and information, as requested or scheduled, to include (but not limited to): hours worked, members reviewed, calls made, claims written, and dollars found.
• Elevates provider/client suggestions and concerns to appropriate Audit Manager, and offer solutions as needed.
• Ensures alignment between strategic goal setting process and performance management process to ensure the organization has the depth and breadth of talent to achieve organizational goals.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.

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.

Qualifications

Education/Certification/Licenses (required):

 

• Associate or Bachelor's degree in nursing.
• RN License (active /unrestricted in state of residence).
• Case Management Certification (preferred).
• Coding or Clinical Documentation Certification (preferred)

 

Experience: 

• 2+ years’ prior management or supervisory experience preferred.
• 5+ years of related experience in: Auditing, Quality or Appeals focused on these types of audits: Place of Service, Short Stay & Readmission.  
• Computer proficiency in Microsoft Excel, Access and system databases are required.
• Prior Healthcare Billing and/or claims experience desired, but not required.
• Ability to mentor staff and enhance performance as it relates to the quality and productivity of their audits.
• 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.

Mental Requirements:

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

Working Conditions and Physical Requirements:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands and/or fingers.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $110,000 to $130,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

 

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

 

Date of posting: 6/11/2026 (Reposted - 7/1/2026)

Applications are assessed on a rolling basis. We anticipate that the application window will close on 8/11/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-Remote##LI-JJ1#senior