Payment Insight Analyst I

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $19 - $22 / hour

⏰ Full Time

🟢 Junior

🧐 Analyst

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Review internal and client systems to determine eligibility and payment methodologies for healthcare claims • Analyze claim documentation to identify accurate repricing approaches based on contractual terms • Interpret and apply client-specific requirements to the claim repricing process • Reprice claims in accordance with established guidelines and client expectations • Partner with internal audit teams to support compliance and quality improvement initiatives • Meet or exceed performance metrics for accuracy, timeliness, and productivity • Adhere to defined workflows and Standard Operating Procedure (SOP) documents • Maintain detailed and organized documentation of repricing activities and outcomes • Identify discrepancies or potential issues in claims and escalate them per company protocols • Communicate with team members and other departments to resolve claim-related questions • Participate in training and stay updated on policy, procedure, and client requirement changes • Support process improvements to enhance claim repricing accuracy and efficiency • Maintain confidentiality of sensitive client and patient information in compliance with company policies and HIPAA regulations • Assist in compiling operational reports and data as requested by management • Contribute to a positive team environment • Complete annual performance review/goal-setting responsibilities, special projects, and other assigned duties

🎯 Requirements

• Minimum one-year professional experience • High school diploma or GED required • Associate’s or Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field preferred • Relevant coursework or training in healthcare claims, insurance, or data analysis is a plus • Minimum one year of experience in a healthcare, insurance, or claims processing environment preferred • Education experience can be substituted in lieu of professional experience • Experience working with data entry, documentation, or administrative tasks • Experience adhering to quality standards and compliance processes is a plus • Strong attention to detail and accuracy in reviewing and processing data • Excellent analytical and problem-solving abilities • Ability to interpret contracts, guidelines, and client requirements • Proficiency with computer systems and basic office software, including Microsoft Excel, Word, and Outlook • Effective written and verbal communication skills • Ability to follow established workflows and SOPs • Strong organizational and time management skills to meet deadlines and performance metrics • Ability to work independently and as part of a team • Willingness to learn and adapt to new processes and systems • Professionalism and commitment to confidentiality and HIPAA compliance • Must be able to provide high-speed internet access/connectivity and maintain an office setup • Must be able to provide a dedicated, secure work area • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • 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 over 40 per week, or as required by applicable state law • Reasonable accommodation, where applicable