Payment Accuracy Specialist

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

📋 Description

• Analyze and review claims, as well as member and group data, to pinpoint recoverable claims.

• Determine the correct order of liability for clients’ members.

• Accurately input claim recovery details into Cotiviti's proprietary software tools.

• Provide assistance with inquiries throughout the claim recovery process.

• Operate under direct supervision while meeting production and quality standards.

• Utilize CMS and NAIC guidelines to establish the order of liability.

• Employ Recovery Management System (RMS), COB Tracker, and client-specific systems for member investigations.

• Document precise notes in Cotiviti and/or client audit tools.

• Assess concepts and claim identifications for clients.

• Prepare and review responses to disputes raised by internal and external clients.

• Classify errors and overpayments for healthcare clients.

• Identify opportunities for continuous improvement in reporting and research processes.

• Adhere to Cotiviti policies, procedures, HIPAA requirements, and external regulations.

• Fulfill annual Performance Plan responsibilities and complete assigned special projects.

⛳️ Requirements

• High School Diploma - Required.

• Bachelor’s degree (Preferred) and/or a minimum of one (1) year of relevant experience in healthcare.

• Recommended to have at least 1-year of Cotiviti experience for those pursuing their next internal opportunity.

• Experience in the healthcare industry, with knowledge of Coordination of Benefits (Preferred).

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

• Exceptional verbal and written communication abilities.

• Passion for working with extensive datasets and diverse databases.

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

• Remarkable attention to detail.

• Strong critical thinking skills with the ability to assess complex scenarios and propose practical solutions.

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

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

• Ability to identify issues that require further investigation.

• Must provide a dedicated, secure workspace.

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

• Must be capable of performing duties with or without reasonable accommodation.

🏝️ Benefits

• Discretionary bonus consideration.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) each year, 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.

• Remote work arrangement.

• Provision of a dedicated, secure work area and high-speed internet/office setup as a working condition.