Senior Payment Accuracy Specialist – Healthcare

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $37 - $40 / hour

⏰ Full Time

🟠 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 healthcare payment audit concepts • Gain client acceptance for audit concepts and expand concepts based on customer requirements • Train audit staff to execute basic, intermediate, and complex audit projects • Evaluate audit concept effectiveness and generate high-quality recoverable claims • Conduct and document complex audit projects independently • Assist Audit Managers with audit productivity, quality, and revenue goals • Develop new reports, tools, processes, and technological improvements with Business Optimization and audit teams • Own quality control by reviewing auditor claims before and after client submission • Prepare responses to client disputes and oversee claim validation • Review provider contracts and research medical policies and state and federal statutes • Validate new claim types and audit concepts for recoveries, collectability, and client acceptance • Mentor and develop less-tenured audit team members • Perform QA claim association and ensure proper use of proprietary software, reports, and IT resources

🎯 Requirements

• Bachelor's degree preferred • Three (3) years of Cotiviti direct audit experience OR four (4) years of related experience in healthcare billing, healthcare/medical claims, reimbursement, or analytics • Experience using SQL required • Computer proficiency in Microsoft Excel, Access, and system databases required • Ability to mentor staff and enhance auditor quality and productivity • Prior healthcare billing and/or claims experience desired • Working knowledge of applicable industry-based standards • Excellent verbal and written communication skills • Ability to work effectively independently and in a team environment • Must provide a dedicated, secure work area • Must provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefits

• Discretionary bonus consideration • 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 working more than 40 hours per week, or as required by applicable state law • Career growth opportunities