Itemized Bill Review Program Manager

The Itemized Bill Review (IBR) Program Manager oversees and leads IBR business operations including claim workflow, vendor performance management, inventory management, and timely and accurate completion of client deliverables. This role entails implementing strategy, tracking milestones and performance, communicating progress, removing obstacles, gaining alignment, escalating issues as needed, and delivering results on time. In addition, this role is responsible for adhering to contractual commitments and delivering customer satisfaction consistent with Cotiviti and client policies and procedures.

IBR Workflow Oversight:

Monitors IBR end-to-end pipeline to ensure successful and timely claim processing from selections to audit findings and appeal processing.
• Reviews client performance targets and ensures IBR program is achieving KPI's (Selections, MR Requests, MR Receipts, Records Audited, Change Rate, Gross ID, Appeal Rate, Appeal Upheld and OT Rates, Accuracy, Audit Sustainability, Conversion, Voids, etc)
• Identifies and facilitates resolution of workflow issues impacting IBR claim pipeline through coordination across Clinical Chart Validation's (CCV) interdisciplinary teams.
• Ensures Production Support tickets are worked timely.
• Coordinates with CCV Client Service Director and Client Service Manager Teams for any client issues and escalations.

IBR Vendor Relationship Management:

• Serves as the primary point of contact between CCV and the vendor.
• Develop and maintain strong, positive relationships with vendor representatives.
• Leads vendor team to ensure adherence to workflows and timely completion of deliverables.
• Facilitates regular meetings and communications to ensure alignment and address any issues promptly.
• Coordinates with HR/Compliance, Security, and 3PI to manage access for supply partners.

Contract Management:

• Ensures vendor meets all contractual obligations, including client specific SLAs, accuracy, audit and appeal turnaround times, and overpayment identification goals.
• Monitors vendor performance against agreed metrics and KPIs.
• Addresses contractual discrepancies or issues, escalating as necessary.
• Ensures the vendor submits accurate invoices and approvals for finance processing and provides finance with billing details for client invoices monthly.
• Performance Monitoring and Improvement:
• Continuously monitors program and vendors' performance, identifying areas for improvement.
• Reviews progress against established metrics and direct activities as needed to ensure the achievement of business goals and customer expectations.
• Implements performance improvement plans as needed.
• Ensures audits and appeals are conducted accurately and within the agreed turnaround times.

Quality Assurance:

• Collaborate closely with the vendor to ensure that audit processes are thorough and accurate.
• Review audit findings to ensure consistency and accuracy.
• Implement quality control measures to maintain high standards.
• Develop and implement key metrics to drive performance in quality and productivity and to ensure that the customer experience is consistent and satisfactory across all phases of the audit.

Reporting and Analysis:

• Develop and maintain comprehensive reports on vendor performance, including SLA adherence, accuracy rates, turnaround times, and client savings.
• Analyze data to identify trends and areas for improvement.
• Provide regular updates to senior management and other stakeholders.

Compliance and Risk Management:

• Ensure that all vendor activities comply with relevant regulations and industry standards.
• Identify and mitigate risks associated with the vendor relationship.
• Facilitate issue resolution between vendor, client, and Cotiviti, escalating to senior management when necessary.
• Stay abreast of regulatory requirements and industry standards related to IBR auditing.
• Ensure compliance with relevant laws, regulations, and standards in audit activities.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

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 the requirements of the job change.

• Bachelor's degree with 5+ years of relevant healthcare experience or equivalent combination of education and work experience with healthcare payers.
• A degree in nursing, health administration, health information management, or a related field.
• Nationally recognized coding certification in good standing is preferred e.g., CPC, CCS
• Demonstrated program management abilities such as evaluation, planning, and execution.
• Knowledge of the healthcare payer marketplace, competitive landscape, financial acumen, and understanding of business drivers.
• 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.
• Strong knowledge of HIPAA regulations and experience in compliance oversight.
• Ability to present results and strategies to senior management while tailoring communication to the audience's knowledge level.
• Proven ability to manage customer, supply partner, and staff relationships effectively. Strong written and verbal communication skills, leadership, team building, and motivational abilities, with a demonstrated background in establishing and tracking key performance metrics.

Cognitive/Mental Requirements:

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Attention to Detail.
• Making timely decisions in the context of a workflow.
• Skill in addressing and resolving conflicts within the team or with external partners
• 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:

• Occasional Travel as assigned by Senior Leadership.
• Remaining professional and available for video calls.
• Remaining in a stationary position, often standing, or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• No adverse environmental conditions are expected.
• 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 $95,000 to $130,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

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: 6/24/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 8/24/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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