Payment Accuracy Specialist 2

Cotiviti • Remote,

4d • $29 - $34 • Remote

About The Position

Cotiviti Healthcare is seeking innovative thinkers and creative problem solvers for its healthcare recovery team as a Payment Accuracy Specialist 2. This role is part of the Data Mining Business Unit (BU), which configures custom claim reviews to investigate billing compliance issues. The Specialist 2 will develop new and existing audit concepts, gain client acceptance, train other specialists, and evaluate audit effectiveness. This role involves auditing client data to identify recoverable claims for Cotiviti and its clients, conducting complex audit projects with limited supervision, and acting as a mentor and trainer for less experienced team members. The position requires a high degree of independent judgment and professional skepticism.

Requirements

• High School Diploma
• Minimum of at least 4 - 6 years of related experience in healthcare.
• 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.
• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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 years of Cotiviti experience is recommended for individuals seeking their next opportunity internally.
• Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity.

Responsibilities

• Develop new and existing audit concepts, gain client acceptance, train all Specialist levels to execute audit projects, and evaluate the effectiveness of audit concepts.
• Audit client data and generate high quality recoverable claims.
• Conduct and train more complex audit projects with some to limited supervision.
• Act as a mentor, trainer, and developer of less-tenured team members.
• Apply a high degree of independent judgment and professional skepticism.
• Work under moderate supervision and be monitored for efficiency in production and quality review.
• Build and maintain 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.
• Utilize Cotiviti audit tools (Recovery Management System (RMS), specific client systems) for auditing, review simple-medium proprietary reports, and have an expert understanding of Microsoft Excel and client applications.
• Perform audit procedures using healthcare experience, including identifying and defining issues, developing criteria, reviewing, and analyzing evidence for medium and complex reports.
• Analyze paid claims and identify audit findings, including documentation for training and knowledge sharing.
• Work with Engineering to increase the efficiency of tools and reporting.
• Update current reports, develop and run custom queries, and validate the accuracy of current reports.
• Make determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
• Meet or exceed standards for productivity, maintaining production goals and standards set by the audit for the auditing concept.
• Achieve the expected level of quality and quantity for assigned work (e.g., hit rate, claims written, vendor/project volume completion, ID and/or fees per hour).
• Meet or exceed standards for quality by achieving the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Respond to inquiries and disputes on all claims written, providing verification of claims validation and confirmation.
• Review transaction types, client contracts/vendor agreements, and client data with limited supervision to identify potential over or underpayments.
• Make recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies.
• Onboard new hires and/or train existing staff on new concepts and processes.
• Identify new claim types and concept expansion using proven methodologies to research and substantiate claims outside the audit concept.
• Enlist others internally or externally to help validate, suggest, develop, and analyze high-quality, high-value concepts and/or process improvements, tool enhancements, etc.
• Recommend new concepts and processes based on experience and in-depth knowledge of client contract terms and complex claim types.
• Develop and implement new ideas, approaches, and/or technological improvements that support and enhance audit production.
• Use advanced validation methods to test and produce a desired/intended result of the new concept.
• Collaborate with Engineering in the development of new reports and tool functionality.
• Demonstrate understanding of Cotiviti policies & procedures, and external regulatory requirements.
• Ensure confidentiality and security of all data, adhering to all HIPAA laws and requirements.
• Ensure the work environment is safe and complies with industry standards.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Disability insurance
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED