Payment Accuracy Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $25 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 relevant facts, information, and conclusions supporting the work and validating claims • Share audit knowledge within the team • Apply 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 • Perform audits covering Data Mining, Claim Adjudication, Contract Compliance, Provider Billing and Duplicate Payment Reviews, Policy and Reimbursement Analysis, and Quality Assurance • Enter overpayments accurately into Cotiviti systems • Discuss audit findings with the audit team • Update reports, develop and run custom queries, and validate report accuracy • Make recovery determinations based on client contract terms and likelihood of acceptance • Meet productivity, attendance, production, quality, hit-rate, claims, volume, ID, and fees-per-hour standards • Respond to inquiries on claims written and provide concise written claim validation and justification • Review transaction types, client contracts, vendor agreements, and client data to identify potential overpayments and underpayments • Recommend medical policy, state and federal statute, and reimbursement methodology applications • Participate in onboarding and cross-training • Research potential claims outside the assigned audit concept and identify new claim types • Suggest and analyze concepts, process improvements, and tool enhancements • Recommend and help develop new concepts, processes, approaches, and technological improvements • Test validation methods and produce intended results for new concepts • Collaborate with Engineering on development of new reports • Perform duties in accordance with Cotiviti policies, procedures, and external regulatory requirements • Ensure confidentiality and security of data while adhering to HIPAA requirements

🎯 Requirements

• High School Diploma - Required • Bachelor’s degree (Preferred) and/or a minimum of at least (2 - 4) year/s related experience in healthcare • Healthcare industry experience, including knowledge of Medicaid Claims, strongly preferred • Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access) • Excellent verbal and written communication skills • Strong interest in working with large data sets and various databases • Ability to work independently and in a team environment • Ability to analyze large volumes of data and identify trends, discrepancies, and anomalies • Exceptional attention to detail for accuracy in financial records and audit findings • Strong critical thinking skills and ability to assess complex situations and propose practical solutions • Ability to make informed decisions based on data, regulations, and auditing standards • Strong understanding of auditing standards, regulations, and industry best practices • Ability to recognize issues requiring further investigation • Strong time management skills and ability to manage multiple tasks simultaneously • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • Must maintain confidentiality and security of data in accordance 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 • Remote work arrangement • Dedicated, secure work area and high-speed internet/office setup supported as working conditions