Payment Accuracy Specialist

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

📋 Description

• Create and enhance audit concepts while securing client approval.

• Educate all Specialist levels to carry out audit initiatives.

• Assess the effectiveness of audit methodologies.

• Review client data and produce high-caliber recoverable claims.

• Conduct and lead intricate audit projects with minimal supervision.

• Mentor, guide, and nurture junior team members.

• Implement CMS and NAIC guidelines to determine the appropriate liability order.

• Utilize Cotiviti audit tools, Recovery Management System (RMS), client systems, Microsoft Excel, and client applications.

• Identify and articulate issues, establish criteria, examine evidence, and audit medium to complex reports.

• Execute audits involving Data Mining, Claim Adjudication, Contract Compliance, Provider Billing and Duplicate Payment Reviews, Policy and Reimbursement Analysis, and Quality Assurance.

• Analyze paid claims to uncover audit findings, including documentation for training and knowledge dissemination.

• Collaborate with Engineering to enhance tool and reporting efficiency.

• Refresh reports, create and execute custom queries, and verify report accuracy.

• Assess recovery potential based on client contract stipulations and previous insights.

• Adhere to productivity, quality, attendance, and audit output benchmarks.

• Address claim inquiries and disputes, offering clear factual validation and justification.

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

• Suggest medical policy applications, state and federal statutes, and reimbursement strategies.

• Facilitate onboarding for new hires and instruct current staff on concepts and procedures.

• Discover new claim types and broaden concepts through research and validation techniques.

• Propose new concepts, processes, reports, and enhancements to tool functionality.

• Partner with Engineering to design new reports and tools.

• Comply with Cotiviti policies, procedures, regulatory mandates, HIPAA regulations, and data security protocols.

⛳️ Requirements

• High School Diploma - Required.

• Bachelor’s degree (Preferred) and/or a minimum of 4 to 6 years of relevant experience in healthcare.

• A minimum of 3 to 4 years of Cotiviti experience is recommended for those pursuing internal opportunities.

• Experience in the healthcare industry, including familiarity with claim adjustments, provider contracts, reimbursement policies, and payment integrity.

• Proficient in computer usage, including Microsoft Office (Word, Excel, Outlook, Access).

• Previous SQL experience is strongly preferred.

• Exceptional verbal and written communication abilities.

• Strong interest in working with large data sets and diverse databases.

• Ability to thrive in both individual and team settings, showcasing self-motivation for achieving success.

• Comprehension of Cotiviti Core Values, Strategic Pillars, and Operations Disciplines.

• Capability to analyze substantial data volumes and identify trends, discrepancies, and anomalies.

• Remarkable attention to detail for accuracy in financial records and audit conclusions.

• Strong critical thinking skills to evaluate complex situations, pinpoint key issues, and suggest practical solutions.

• Ability to make informed decisions based on data, regulations, and auditing standards.

• Strong grasp of auditing standards, regulations, and industry best practices.

• Ability to identify issues that warrant further investigation and scrutinize financial records or processes.

• Capability to work efficiently as part of an audit team.

• Strong time management skills and the ability to juggle multiple tasks simultaneously.

• Must provide a dedicated, secure workspace.

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

🏝️ Benefits

• Discretionary bonus consideration

• Medical insurance

• Dental insurance

• Vision insurance

• Disability insurance

• Life insurance

• 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 eligibility for nonexempt employees for hours worked over 40 per week or as mandated by state law

• Remote work arrangement

• High-speed internet access and office setup/maintenance provided by the team member