Payment Insight Analyst I

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $19 - $22 / hour

⏰ Full Time

🟢 Junior

🧐 Analyst

🚫👨‍🎓 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

• Review internal and client systems to determine eligibility and payment methodologies for healthcare claims • Analyze claim documentation and identify accurate repricing approaches based on contractual terms • Interpret and apply client-specific requirements to claim repricing • Ensure claims are repriced according to established guidelines and client expectations • Partner with internal audit teams to support compliance and quality improvement initiatives • Meet or exceed accuracy, timeliness, and productivity performance metrics • Follow defined workflows and Standard Operating Procedure (SOP) documents • Maintain detailed documentation of repricing activities and outcomes • Identify claim discrepancies or potential issues and escalate them according to company protocols • Communicate with team members and other departments to resolve claim-related questions • Participate in training and stay updated on policies, procedures, and client requirements • Support process improvements to improve claim repricing accuracy and efficiency • Maintain confidentiality of client and patient information in compliance with company policies and HIPAA regulations • Assist with operational reports and data as requested by management • Complete special projects and other assigned duties

🎯 Requirements

• Minimum one year of 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 • Equivalent combination of education and experience may be considered • Minimum one year of experience in a healthcare, insurance, or claims processing environment preferred • Experience 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 • 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 • Ability to provide high-speed internet access/connectivity and maintain an office setup • Ability to provide a dedicated, secure work area • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• 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 • Remote work arrangement • Overtime pay for nonexempt employees working more than 40 hours per week, or as required by applicable state law