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 for Cotiviti and its clients • Conduct or assist with identifying, validating, and documenting moderate to complex audit projects • Document facts, information, and conclusions to support work performed and validate claims • Build and maintain understanding 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 • Enter overpayments accurately into the Cotiviti system • Identify and discuss audit findings with the audit team and participate in knowledge sharing • Update reports, develop and run custom queries, and validate report accuracy • Make determinations based on client contract terms and likelihood of recovery acceptance • Meet productivity, attendance, production, quality, hit-rate, claims, project-volume, ID, and fee-per-hour standards • Respond to inquiries regarding claims written 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 applications, state and federal statutes, and reimbursement methodologies • Participate in onboarding new hires and cross-training efforts • Research and identify new claim types and potential claims outside the audit concept • Suggest, develop, and analyze concepts, process improvements, and tool enhancements • Recommend new concepts and processes using client, contract, and complex claim knowledge • Develop and implement ideas, approaches, and technology improvements supporting audit production • Evaluate information, draw logical conclusions, and apply validation methods to test new concepts • Collaborate with Engineering on developing new reports • Follow Cotiviti policies, procedures, external regulatory requirements, HIPAA laws, and data-security standards

🎯 Requirements

• High School Diploma - Required • Bachelor’s degree preferred and/or a minimum of 2-4 years of 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 work independently and in a team environment • 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 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 investigate issues, inconsistencies, and irregularities in financial records or processes • Strong time management skills and ability to manage multiple tasks simultaneously • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance • 2-3 years of Cotiviti experience is recommended for individuals seeking their next opportunity internally

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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 with Cotiviti