Payment Accuracy Specialist

🕒 August 10

🇺🇸 United States – Remote

💵 $25 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 34%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, and conclusions supporting audit work and claim validation • Build and maintain knowledge of 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 involving Data Mining, Claim Adjudication, Contract Compliance, Provider Billing, Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance • Enter overpayments accurately into the Cotiviti system • Discuss audit findings with the audit team and share knowledge • Update reports, develop and run custom queries, and validate report accuracy • Make determinations using client contract terms and likelihood of recovery acceptance • Meet productivity, quality, attendance, and production goals • Respond to inquiries about written claims and provide concise written claim validation and justification • Review transaction types, client contracts/vendor agreements, and client data to identify potential overpayments or underpayments • Recommend medical policy, state and federal statute, and reimbursement methodology applications • Participate in onboarding new hires and cross-training • Research and identify potential claims outside the assigned audit concept • Suggest, develop, and analyze new concepts, process improvements, and tool enhancements • Recommend and help implement new audit concepts, processes, and technological improvements • Test validation methods and desired results for new concepts • Collaborate with Engineering on new report development • Perform duties in accordance with Cotiviti policies, procedures, and external regulatory requirements • Ensure confidentiality and security of data in compliance with HIPAA

🎯 Requirements

• High School Diploma — Required • Bachelor’s degree preferred and/or at least 2–4 years of related experience in healthcare • 2–3 years of Cotiviti experience recommended for individuals seeking their next opportunity internally • 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 • Strong critical thinking and 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 and ability to manage multiple tasks • 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 comply with HIPAA laws and requirements

🏖️ 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 for nonexempt employees for hours worked over 40 hours per week, or as required by applicable state law • Dedicated, secure work area and high-speed internet/office setup support are required for the role