Senior Payment Accuracy Specialist, Healthcare

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

📋 Description

• Create innovative concepts for healthcare payment accuracy audits, both new and existing.

• Obtain client approval and broaden the scope of accepted audit concepts in line with customer needs.

• Educate audit personnel to carry out basic, intermediate, and advanced audit initiatives.

• Independently manage and document complex audit projects.

• Assess the effectiveness of audit concepts, recoveries, collectability, and client satisfaction.

• Work in conjunction with Business Optimization and audit teams to design new reports, tools, and processes.

• Examine auditor claims for quality assurance before and after client submission.

• Track audit quality and productivity indicators, including hit rates, claims processed, and identification rates per hour.

• Prepare responses to client disputes and supervise claim validation processes.

• Analyze provider contracts and investigate medical policies, as well as state and federal regulations.

• Validate new claim categories and audit concepts.

• Guide, evaluate, and foster the growth and staffing of audit team members.

• Ensure the effective utilization of proprietary software, reports, and IT resources.

⛳️ Requirements

• A bachelor's degree is preferred.

• A minimum of three (3) years of direct audit experience with Cotiviti or four (4) years of relevant experience in healthcare billing, medical claims, reimbursement, or analytics.

• Proficiency in SQL is required.

• Competence in Microsoft Excel, Access, and system databases is essential.

• Capability to mentor staff and improve auditor quality and productivity.

• Previous experience in healthcare billing and/or claims is preferred.

• Familiarity with relevant industry standards is necessary.

• Exceptional verbal and written communication skills are a must.

• Ability to work effectively both independently and as part of a team.

• Must be able to provide a secure and dedicated work environment.

• High-speed internet access/connectivity and proper office setup and maintenance must be provided.

🏝️ Benefits

• Consideration for discretionary bonuses.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance.

• Life insurance coverage.

• Participation in a 401(k) savings plan.

• Paid family leave benefits.

• Nine paid holidays each year.

• Paid Time Off (PTO) ranging from 17 to 27 days per year, depending on level and duration of service.

• A secure dedicated workspace and high-speed internet/office setup are required for remote work.