Payment Integrity Specialist

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Audit healthcare claims on behalf of our private health insurance clients to detect and recover overpayment. • Review clinical documentations submitted by providers. • Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover overpayments. • Support the growth of the Payment Integrity Practice by supporting business development activities. • Strictly respect the confidentiality of all sensitive company and client information.

🎯 Requirements

• One of the following qualifications: Bachelor’s Degree (Nursing or equivalent) with experience in Critical care, emergency department or operating theatre experience preferred. • Health Information Manager. • Clinical coder with a coding qualification with 5-8 years' experience. • Experience in auditing private hospital claims. • Clinical coding experience highly desired. • Understanding of private health insurance legislation and private hospital funding models. • Experience working in the private health insurance sector or in private hospital audit. • Familiarity with 3M codefinder. • Excellent written and verbal communication skills. • Effective time management, planning and organizational skills. • Maintain knowledge and expertise by attending appropriate educational sessions. • Ability to work remotely from home office.

🏖️ Benefits

• Health Information Manager • Clinical coder with a coding qualification with 5-8 years' experience.