Payment Accuracy Specialist

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $29 - $33 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 • Gain client acceptance for audit concepts • Train all Specialist levels to execute audit projects • Evaluate the effectiveness of audit concepts • Audit client data and generate recoverable claims • Conduct and train more 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 proprietary reports • Perform audit procedures involving issue identification, criteria development, evidence review, and analysis • Conduct audits across Data Mining, Claim Adjudication, Contract Compliance, Provider Billing, Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance • Analyze paid claims and document audit findings 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 • Meet productivity and quality standards for assigned audits • Respond to inquiries and disputes regarding written claims and provide claim validation • Review transaction types, vendor agreements, client contracts, and data to identify potential overpayments or underpayments • Recommend medical policy, statutory, and reimbursement methodology applications • Onboard new hires and train existing staff on new concepts and processes • Research and substantiate new claim types and audit concept expansions • Recommend new concepts, processes, reports, tool functionality, and process improvements • Collaborate with Engineering on reports and tool functionality • Follow Cotiviti policies, procedures, and external regulatory requirements

🎯 Requirements

• High School Diploma - Required • Bachelor’s degree preferred and/or a minimum of at least 4–6 years related experience in healthcare • 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 • 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 recognize issues requiring further investigation • 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 ensure confidentiality and security of data in compliance with HIPAA laws and requirements

🏖️ Benefits

• Discretionary bonus consideration • Overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on specific level and length of service

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