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 work performed and claim validation • Build and maintain understanding of CMS and NAIC guidelines to establish the correct order of liability • Use Cotiviti Recovery Management System (RMS), client systems, Microsoft Excel, and client applications for auditing • 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 & Reimbursement Analysis, and Quality Assurance • Enter overpayments accurately into Cotiviti systems • Update reports, develop and run custom queries, and validate report accuracy • Discuss audit findings with the audit team and participate in knowledge sharing • Meet or exceed productivity, quality, attendance, hit-rate, claims, volume, identification, and fee-per-hour standards • Respond to inquiries regarding written claims and provide concise written verification of claim validation • Review transaction types, client contracts, vendor agreements, and client data to identify potential overpayments or underpayments • Make recommendations regarding medical policy, state and federal statutes, and reimbursement methodologies • Participate in onboarding new hires and cross-training • Research new claim types and identify opportunities for concept expansion and process improvements • Recommend and develop new concepts, processes, tool enhancements, and technological improvements • Collaborate with Engineering on development of new reports when needed • Perform duties in accordance with Cotiviti policies, procedures, and external regulatory requirements • Ensure confidentiality and security of all data in compliance with HIPAA

🎯 Requirements

• High School Diploma - Required • Bachelor’s degree preferred and/or a minimum of 2-4 years 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 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 decision-making skills • Strong understanding of auditing standards, regulations, and industry best practices • Ability to recognize issues requiring further investigation • Ability to work independently and as part of an audit team • Strong time management skills • 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 compliance with HIPAA laws and requirements

🏖️ 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 in excess of 40 hours per week, or as required by applicable state law • Remote work arrangement with a dedicated, secure work area and high-speed internet/office setup

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