Payment Accuracy Specialist 2

Cotiviti

77d • $29 - $33

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.
• Bachelor’s degree preferred and/or a minimum of 4-6 years related experience in healthcare.
• At least 3-4 years of Cotiviti experience recommended for internal candidates.
• Healthcare industry experience, including knowledge of claim adjustments and reimbursement policies.
• 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.

Responsibilities

• Work under moderate supervision and monitor efficiency in production and quality review of assigned work.
• Build and maintain a basic understanding of CMS and NAIC guidelines to establish the correct order of liability.
• Utilize Cotiviti audit tools and Microsoft Excel to complete auditing and review proprietary reports.
• Perform audit procedures including identifying and defining issues, developing criteria, and analyzing evidence.
• Conduct advanced analysis of paid claims and identify audit findings.
• Update current reports, develop and run custom queries, and validate the accuracy of reports.
• Meet or exceed standards for productivity and quality in assigned work.
• Respond to inquiries and disputes on claims written with concise verification.
• Review transaction types, client contracts, and data to identify potential over or underpayments.
• Onboard new hires and train existing staff on new concepts and processes.
• Identify new claim types and recommend new concepts and processes based on experience.
• Collaborate with Engineering in the development of new reports and tool functionality.
• Ensure confidentiality and security of all data, adhering to HIPAA laws.

Benefits

• Medical, dental, vision, disability, and 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees