Payment Accuracy Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $25 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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 client data and generate high-quality recoverable claims • Conduct or assist with identification, validation, and documentation of moderate to complex audit projects • Document facts, information, and conclusions supporting audit work and claim validation • Build and maintain understanding of CMS and NAIC guidelines to establish the correct order of liability • Use Cotiviti audit tools, Recovery Management System (RMS), client systems, Microsoft Excel, and client applications • Audit standard reports and paid claims to identify overpayments and underpayments • Work across Data Mining, Claim Adjudication, Contract Compliance, Provider Billing, Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance • Enter overpayments accurately into the Cotiviti system • Discuss audit findings with the audit team and participate in knowledge sharing • Update reports, develop and run custom queries, and validate report accuracy • Determine recovery acceptance likelihood based on client contract terms and prior knowledge • Meet productivity, attendance, production, quality, hit-rate, claims-written, project-volume, ID, and fee-per-hour standards • Respond to inquiries about written claims and provide concise written claim validation • Review transaction types, client contracts, vendor agreements, and client data to identify potential overpayments and underpayments • Recommend medical policy application, state and federal statutes, and reimbursement methodologies • Participate in onboarding new hires and cross-training • Research potential claims outside the audit concept and identify new claim types • Suggest, develop, and analyze audit concepts, process improvements, and tool enhancements • Research, develop, and implement new audit ideas, approaches, and technological improvements • Evaluate information and draw logical conclusions using validation methods • Collaborate with Engineering on new report development • Follow Cotiviti policies, procedures, regulatory requirements, and HIPAA data confidentiality and security standards

🎯 Requirements

• High School Diploma — Required • Bachelor’s degree preferred • 2–4 years of related experience in healthcare • Healthcare industry experience, including knowledge of Medicaid Claims, strongly preferred • Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access) • Strong interest in working with large data sets and various databases • Ability to analyze large volumes of data and identify trends, discrepancies, and anomalies • Exceptional attention to detail • Strong critical thinking and practical problem-solving skills • Ability to make informed decisions based on data, regulations, and auditing standards • Strong understanding of auditing standards, regulations, and industry best practices • Ability to investigate financial records or processes to uncover issues and irregularities • Ability to work effectively as part of an audit team • Strong time management skills and ability to juggle multiple tasks • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance • Ability to maintain confidentiality and comply with HIPAA laws and requirements

🏖️ Benefits

• Discretionary bonus consideration • Overtime pay for hours worked in excess of 40 hours per week, or as required by applicable state law • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the candidate