Senior Payment Accuracy Specialist – Healthcare

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

📋 Description

• Create and refine innovative healthcare payment audit concepts.

• Obtain client approval for audit concepts and adjust them according to customer needs.

• Provide training for audit staff on executing basic, intermediate, and advanced audit projects.

• Assess the effectiveness of audit concepts and produce high-quality recoverable claims.

• Independently conduct and document intricate audit projects.

• Support Audit Managers in achieving productivity, quality, and revenue objectives.

• Collaborate with Business Optimization and audit teams to develop new reports, tools, processes, and technological enhancements.

• Ensure quality control by reviewing auditor claims prior to and following client submission.

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

• Analyze provider contracts and investigate medical policies along with state and federal regulations.

• Validate new claim types and audit concepts for recoveries, collectability, and client approval.

• Mentor and nurture less-experienced audit team members.

• Perform QA claim association and guarantee the proper utilization of proprietary software, reports, and IT resources.

⛳️ Requirements

• A Bachelor's degree is preferred.

• 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.

• Strong computer skills in Microsoft Excel, Access, and system databases are necessary.

• Capable of mentoring staff to improve auditor quality and productivity.

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

• Familiarity with industry-based standards is essential.

• Exceptional verbal and written communication abilities.

• Ability to work efficiently both independently and in a team setting.

• Must provide a secure and dedicated workspace.

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

🏝️ Benefits

• Consideration for discretionary bonuses.

• Medical insurance coverage.

• Dental insurance benefits.

• Vision insurance options.

• Disability insurance protection.

• Life insurance coverage.

• Participation in a 401(k) savings plan.

• Paid family leave provisions.

• Nine paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, based on experience and tenure.

• Overtime pay for nonexempt employees working over 40 hours a week, or as mandated by applicable state laws.

• Opportunities for career advancement.