Payment Accuracy Specialist

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

📋 Description

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

• Perform or assist in the identification, validation, and documentation of moderately complex audit projects.

• Record facts, information, and conclusions that support audit activities and claim validation.

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

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

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

• Collaborate across Data Mining, Claim Adjudication, Contract Compliance, Provider Billing, Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance.

• Accurately enter overpayments into the Cotiviti system.

• Discuss audit results with the audit team and engage in knowledge sharing.

• Update reports, create and execute custom queries, and ensure report accuracy.

• Assess the likelihood of recovery acceptance based on client contract terms and prior knowledge.

• Achieve productivity, attendance, production, quality, hit-rate, claims-written, project-volume, ID, and fee-per-hour benchmarks.

• Address inquiries regarding written claims and deliver clear written claim validation.

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

• Advise on medical policy application, state and federal statutes, and reimbursement methodologies.

• Contribute to onboarding new employees and cross-training initiatives.

• Investigate potential claims beyond the audit framework and recognize new claim types.

• Propose, develop, and assess audit concepts, process enhancements, and tool improvements.

• Research, create, and implement innovative audit ideas, methodologies, and technological advancements.

• Analyze information and derive logical conclusions using validation techniques.

• Work with Engineering on the development of new reports.

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

⛳️ Requirements

• High School Diploma — Required.

• Bachelor’s degree preferred.

• 2–4 years of relevant experience in healthcare.

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

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

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

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

• Exceptional attention to detail.

• Strong critical thinking and practical problem-solving abilities.

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

• Comprehensive understanding of auditing standards, regulations, and industry best practices.

• Proficiency in investigating financial records or processes to uncover issues and irregularities.

• Ability to collaborate effectively as part of an audit team.

• Strong time management skills and capability to manage multiple tasks.

• Ability to provide a dedicated, secure workspace.

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

• Commitment to maintaining confidentiality and adhering to HIPAA laws and requirements.

🏝️ Benefits

• Discretionary bonus consideration.

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

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) each year, depending on level and duration of service.

• A dedicated, secure workspace along with high-speed internet access/connectivity and office setup and maintenance provided by the candidate.