Senior Payment Accuracy Specialist, Healthcare

🔥 0 minutes 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 accuracy audit concepts • Gain client acceptance and expand approved audit concepts based on customer requirements • Train audit staff to execute basic, intermediate, and complex audit projects • Conduct and document complex audit projects independently • Evaluate audit concept effectiveness, recoveries, collectability, and client acceptance • Collaborate with Business Optimization and audit teams to develop new reports, tools, and processes • Review auditor claims before and after client submission for quality control • Monitor audit quality and productivity metrics, including hit rate, claims written, and identification per hour • 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 • Mentor, assess, and support the progression and staffing of audit team members • 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 well independently and in a team environment • Ability to provide a dedicated, secure work area • Ability to 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 • Secure dedicated work area and high-speed internet/office setup required for remote work