Payment Accuracy Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $29 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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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

• Develop new and existing audit concepts and gain client acceptance. • Train all Specialist levels to execute audit projects. • Evaluate the effectiveness of audit concepts. • Audit client data and generate high-quality recoverable claims. • Conduct and train complex audit projects with limited supervision. • Mentor, train, and develop less-tenured team members. • 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. • Identify and define issues, develop criteria, review and analyze evidence, and audit medium and complex reports. • Perform audits involving Data Mining, Claim Adjudication, Contract Compliance, Provider Billing and Duplicate Payment Reviews, Policy and Reimbursement Analysis, and Quality Assurance. • Analyze paid claims and identify audit findings, including documentation for training and knowledge sharing. • Work with Engineering to improve tool and reporting efficiency. • Update reports, develop and run custom queries, and validate report accuracy. • Determine recovery likelihood based on client contract terms and prior knowledge. • Meet productivity, quality, attendance, and audit production standards. • Respond to claim inquiries and disputes and provide concise factual claim validation and justification. • Review transaction types, client contracts, vendor agreements, and client data to identify potential overpayments or underpayments. • Recommend medical policy applications, state and federal statutes, and reimbursement methodologies. • Onboard new hires and train existing staff on concepts and processes. • Identify new claim types and expand concepts using research and validation methodologies. • Recommend new concepts, processes, reports, and tool functionality improvements. • Collaborate with Engineering to develop new reports and tools. • Follow Cotiviti policies, procedures, regulatory requirements, HIPAA laws, and data security standards.

🎯 Requirements

• High School Diploma - Required. • Bachelor’s degree (Preferred) and/or a minimum of at least (4 - 6) year/s related experience in healthcare. • At least 3 - 4 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally. • Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity. • Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access). • Previous SQL experience strongly preferred. • Excellent verbal and written communication skills. • Strong interest in working with large data sets and various databases. • Ability to work well in an individual and team environment demonstrating self–motivation to deliver success. • Understanding of Cotiviti Core Values, Strategic Pillars, and Operations Disciplines. • 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 and ability to assess complex situations, identify key issues, 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 and probe financial records or processes. • Ability to work effectively as part of an audit team. • 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.

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 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 eligibility for nonexempt employees for hours worked over 40 per week or as required by state law • Remote work arrangement • High-speed internet access and office setup/maintenance provided by the team member