Payment Accuracy Specialist 2

Cotiviti•Remote,

1d•$29 - $34•Remote

About The Position

Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist 2. This role is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. The Specialist 2 is responsible for developing new and existing audit concepts, gaining client acceptance, training all Specialist levels to execute audit projects, and evaluating the effectiveness of audit concepts. Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients. Conducts and trains more complex audit projects with some to limited supervision. Considered a mentor, trainer, and developer of less-tenured team members. Displays a high degree of independent judgment and professional skepticism that enhances the work performed in order to achieve success in the position.

Requirements

High School Diploma - Required.
Minimum of at least (4 - 6) year/s related experience in healthcare.
Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity.
Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access).
Previous SQL experience strongly preferred.
Excellent verbal and written communication skills.
Strong interest in working with large data sets and various databases.
Ability to work well in an individual and team environment demonstrating self–motivation to deliver success.
Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.
Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies.
Exceptional attention to detail to ensure accuracy in financial records and audit findings.
Strong critical thinking skills, with the ability to assess complex situations, identify key issues, and propose practical solutions.
Ability to approach challenges methodically and with a strategic mindset.
Ability to make informed decisions based on available data, regulations, and auditing standards.
Ability to weigh options and make recommendations that align with both compliance requirements and organizational goals.
Strong understanding of auditing standards, regulations, and industry best practices.
Ability to apply these standards consistently to ensure accurate and compliant audit processes.
Ability to recognize when something is wrong or needs further investigation.
Initiative to probe deeper into financial records or processes to uncover issues, inconsistencies, or irregularities.
Ability to work effectively as part of an audit team, sharing insights, collaborating on tasks, and contributing to a positive and productive team dynamic.
Strong time management skills with the ability to juggle multiple tasks simultaneously and efficiently.
Must be able to provide a dedicated, secure work area.
Must be able to provide high-speed internet access / connectivity and office setup and maintenance.

Nice To Haves

Bachelor’s degree
At least 3 - 4 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally.

Responsibilities

Develops new and existing audit concepts, gains client acceptance, trains all Specialist levels to execute audit projects, and evaluates the effectiveness of audit concepts.
Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
Conducts and trains more complex audit projects with some to limited supervision.
Acts as a mentor, trainer, and developer of less-tenured team members.
Displays a high degree of independent judgment and professional skepticism that enhances the work performed in order to achieve success in the position.
Works under moderate supervision and is monitored for efficiency in production and quality review of assigned work.
Builds and maintains a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability.
Utilizes Cotiviti audit tools (Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, and has an expert understanding of Microsoft Excel and client applications.
Performs audit procedures using healthcare experience, including identifying and defining issues, developing criteria, reviewing, and analyzing evidence with the intent to audit medium and complex reports.
Conducts advanced analysis of paid claims and identification of audit findings, including documentation for training and knowledge sharing.
Works with Engineering to increase the efficiency of tools and reporting.
Updates current reports, develops and runs custom queries, and validates the accuracy of current reports used.
Makes determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
Meets or Exceeds Standards for Productivity, maintaining production goals and standards set by the audit for the auditing concept.
Achieves the expected level of quality and quantity for assigned work (i.e. hit rate, claims written, vendor/project volume completion, ID and/or fees per hour).
Meets or Exceeds Standards for Quality by achieving the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
Responds to inquiries and disputes received on all claims written, providing verification of claims validation and confirmation in a concise written manner, utilizing facts and details for justification purposes.
Reviews transaction types, client contracts/vendor agreements, and client data with limited supervision to identify potential over or underpayments.
Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept.
Serves as a skilled resource in onboarding new hires and/or training existing staff on new concepts and processes.
Identifies New Claim Types & Concept Expansion using proven methodologies to research and substantiate claims outside the audit concept.
Enlists others internally or externally to help validate, suggest, develop, and analyze high-quality, high-value concepts and/or process improvements, tool enhancements, etc.
Recommends New Concepts & Processes based on experience and in-depth knowledge of client contract terms and complex claim types.
Develops and implements new ideas, approaches, and/or technological improvements that support and enhance audit production.
Uses advanced validation methods to test and produce a desired/intended result of the new concept.
Collaborates with Engineering in the development of new reports and tool functionality.
Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements.
Ensures that our environment is safe, complying with industry standards.

Benefits

medical
dental
vision
disability
life insurance coverage
401(k) savings plans
paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.
discretionary bonus consideration
overtime pay for hours worked in excess of 40 hours in a given week