Payment Accuracy Specialist

Cotiviti•Remote,

3d•$21 - $25•Remote

About The Position

The Payment Accuracy, Data Mining (DM) Specialist is part of Cotiviti’s Data Mining Business Unit, which configures custom claim reviews to investigate billing compliance issues relating to regulations and contracted policies across products, markets, and provider types. Under direct supervision, the specialist audits client data and identifies recoverable claims for Cotiviti and its clients. The work includes identifying and entering recovery claims, voids, and other over- or underpayment types; documenting facts and conclusions that support the work; and communicating audit recommendations to a supervisory auditor for evaluation, verification, and ongoing learning. The role calls for professional skepticism and is monitored for production efficiency and quality. The specialist audits standard reports and paid claims across areas that may include data mining, claim adjudication, contract compliance, provider billing and duplicate payment reviews, policy and reimbursement analysis, and quality assurance. The role uses Cotiviti’s Recovery Management System and client systems, reviews simple-to-medium proprietary reports, and applies knowledge of healthcare guidelines, contracts, policies, and reimbursement methodologies. The position also involves preparing and evaluating responses to client disputes, meeting production and quality standards, and following Cotiviti policies and applicable regulatory requirements, including HIPAA. The role requires a dedicated, secure work area, high-speed internet access, and an office setup and maintenance. The position has no expected adverse environmental conditions. Base compensation ranges from $21.00 to $24.75 per hour, with specific offers based on factors such as experience, education, skills, certifications, and business needs. The role is eligible for discretionary bonus consideration, and nonexempt employees are eligible for overtime pay as applicable.

Requirements

High school diploma required.
At least 1–2 years of related healthcare experience, or a bachelor’s degree preferred.
Computer proficiency, including Microsoft Word, Excel, and Outlook.
Excellent verbal and written communication skills.
Strong interest in working with large data sets and various databases.
Ability to work independently and as part of a team, demonstrating self-motivation.
Ability to communicate with others to exchange information.
Ability to assess the accuracy, neatness, and thoroughness of assigned work.
Ability to remain in a stationary position, often standing or sitting for prolonged periods.
Ability to perform repeated motions that may include the wrists, hands, and/or fingers.
Ability to provide a dedicated, secure work area and high-speed internet access, connectivity, and office setup and maintenance.
Ability to understand and embody Cotiviti Core Values, Strategic Pillars, and Operations Disciplines.
Regular and predictable attendance and ability to meet audit productivity and quality expectations.

Nice To Haves

Bachelor’s degree.
Healthcare industry experience, including knowledge of Coordination of Benefits.
At least 1–2 years of Cotiviti experience is recommended for internal candidates seeking their next opportunity, such as those in Audit Support positions.
Basic understanding of CMS and NAIC guidelines for establishing the correct order of liability.
Basic understanding of the healthcare industry and a proven track record of delivering results.
Proficiency with Microsoft Excel and client applications.

Responsibilities

Audit client data and identify and enter recovery claims, voids, and other over- or underpayment types under direct supervision.
Document relevant facts, information, and conclusions to support work performed and validate claims.
Communicate audit recommendations to the supervisory auditor for evaluation, verification, and continuous learning.
Use Cotiviti’s Recovery Management System and client systems to perform audits and review simple-to-medium proprietary reports.
Audit standard reports and paid claims to identify claim overpayments and underpayments across assigned audit concepts.
Meet or exceed assigned productivity and quality standards, including production goals, attendance expectations, hit rate, claims written, and identification per hour.
Prepare and evaluate responses to client disputes, internally and externally, as needed.
Review client transactions and build proficiency in provider contracts and vendor agreements.
Make recommendations on medical policy applications, state and federal statutes, and reimbursement methodologies as they apply to the audit concept.
Follow Cotiviti policies and procedures and external regulatory requirements.
Protect the confidentiality and security of data and comply with HIPAA requirements.
Work in accordance with industry safety standards and help ensure a safe environment.

Benefits

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance
401(k) savings plan
Paid family leave
9 paid holidays per year
17–27 days of Paid Time Off (PTO) per year, depending on level and length of service
Discretionary bonus consideration
Overtime pay for eligible nonexempt employees