Payment Accuracy Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Audit client data to produce high-quality recoverable claims.

• Conduct or assist in the identification, validation, and documentation of moderate to complex audit projects.

• Document facts, information, conclusions, and support for claim validation.

• Develop and maintain a thorough understanding of CMS and NAIC guidelines to determine the order of liability.

• Utilize the Cotiviti Recovery Management System, client systems, Microsoft Excel, and client applications.

• Review standard reports and paid claims to detect overpayments and underpayments.

• Execute audits that involve data mining, claim adjudication, contract compliance, provider billing, duplicate payment reviews, policy and reimbursement analysis, and quality assurance.

• Accurately record overpayments in Cotiviti systems.

• Present audit findings and share insights with the audit team.

• Update reports, create and execute custom queries, and validate the accuracy of reports.

• Assess recovery likelihood based on client contract terms.

• Achieve productivity, quality, attendance, and production benchmarks.

• Address inquiries about claims and provide clear written verification of claim validation.

• Analyze transaction types, contracts, vendor agreements, and client data to pinpoint potential overpayments and underpayments.

• Offer recommendations regarding medical policy, state and federal statutes, and reimbursement methodologies.

• Engage in onboarding and cross-training for new hires.

• Research and identify new claim types and opportunities for concept expansion.

• Propose and develop new audit concepts, processes, tool enhancements, and technological advancements.

• Collaborate with Engineering on the development of new reports.

• Adhere to Cotiviti policies, procedures, regulatory requirements, and HIPAA data-security standards.

⛳️ Requirements

• High School Diploma is required.

• A Bachelor’s degree is preferred along with 2–4 years of relevant experience in healthcare.

• It is recommended that internal candidates have 2–3 years of experience with Cotiviti.

• Experience in the healthcare industry, particularly knowledge of Medicaid Claims, is strongly preferred.

• Proficiency in Microsoft Office, including Word, Excel, Outlook, and Access.

• Excellent verbal and written communication abilities.

• A strong interest in working with large datasets and various databases.

• Capability to work independently as well as in a team setting.

• Ability to analyze large quantities of data to identify trends, discrepancies, and anomalies.

• Exceptional attention to detail.

• Strong critical thinking and decision-making capabilities.

• Understanding of auditing standards, regulations, and industry best practices.

• Ability to pinpoint issues that require further investigation.

• Strong time management skills and proficiency in managing multiple tasks.

• Must provide a dedicated, secure workspace.

• Must ensure high-speed internet access/connectivity and maintain office setup.

• Knowledge of CMS and NAIC guidelines.

• Understanding of HIPAA laws and requirements.

• Familiarity with Medicaid claims, client contracts, vendor agreements, and reimbursement methodologies.

🏝️ Benefits

• Discretionary bonus consideration.

• Coverage for medical, dental, vision, disability, and life insurance.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays each year.

• 17–27 days of Paid Time Off (PTO) annually, based on level and length of service.

• Overtime pay for nonexempt employees for hours worked beyond 40 hours per week, or as mandated by applicable state law.

• Opportunities for career advancement.

• Secure dedicated workspace and high-speed internet/office setup provided by the team member.