Payment Accuracy Specialist

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $25 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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👻 Ghost score 0%

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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 facts, information, conclusions, and claim validation support • Build and maintain understanding of CMS and NAIC guidelines to establish order of liability • Use Cotiviti Recovery Management System, client systems, Microsoft Excel, and client applications • Audit standard reports and paid claims to identify overpayments and underpayments • Perform audits involving data mining, claim adjudication, contract compliance, provider billing, duplicate payment reviews, policy and reimbursement analysis, and quality assurance • Enter overpayments accurately into Cotiviti systems • Discuss audit findings and share knowledge with the audit team • Update reports, develop and run custom queries, and validate report accuracy • Determine recovery likelihood based on client contract terms • Meet productivity, quality, attendance, and production standards • Respond to inquiries on claims written and provide concise written verification of claim validation • Review transaction types, contracts, vendor agreements, and client data to identify potential overpayments and underpayments • Make recommendations on medical policy, state and federal statutes, and reimbursement methodologies • Participate in onboarding and cross-training new hires • Research and identify new claim types and opportunities for concept expansion • Recommend and develop new audit concepts, processes, tool enhancements, and technological improvements • Collaborate with Engineering on new report development • Follow Cotiviti policies, procedures, regulatory requirements, and HIPAA data-security standards

🎯 Requirements

• High School Diploma required • Bachelor’s degree preferred and/or 2–4 years of related experience in healthcare • 2–3 years of Cotiviti experience recommended for internal candidates • Healthcare industry experience, including knowledge of Medicaid Claims strongly preferred • Proficiency with Microsoft Office, including Word, Excel, Outlook, and 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 • Strong critical thinking and decision-making skills • Understanding of auditing standards, regulations, and industry best practices • Ability to identify issues requiring further investigation • Strong time management skills and ability to manage multiple tasks • Must provide a dedicated, secure work area • Must provide high-speed internet access/connectivity and office setup and maintenance • Knowledge of CMS and NAIC guidelines • Knowledge of HIPAA laws and requirements • Knowledge of Medicaid claims, client contracts, vendor agreements, and reimbursement methodologies

🏖️ Benefits

• Discretionary bonus consideration • Medical, dental, vision, disability, and 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 • Overtime pay for nonexempt employees for hours worked over 40 hours per week, or as required by applicable state law • Career growth opportunities • Secure dedicated work area and high-speed internet/office setup provided by the team member