Payment Accuracy Specialist

Cotiviti•Remote,

3d•$21 - $25•Remote

About The Position

The Payment Accuracy Data Mining Specialist is part of Cotiviti’s Data Mining Business Unit, which configures custom claim reviews to investigate billing compliance issues involving regulations and contracted policies across products, markets, and provider types. Under direct supervision, the specialist audits client data and identifies recovery claims, voids, and other over- or underpayment types. The specialist documents relevant facts and conclusions to support and validate audit work, and communicates recommendations to a supervisory auditor for evaluation, verification, and continued learning. Professional skepticism is important to success in the role. The specialist works on assigned audits and is monitored for production efficiency and quality. Work may cover data mining, claim adjudication, contract compliance, provider billing and duplicate payment reviews, policy and reimbursement analysis, and quality assurance for various clients. The position reviews simple-to-medium reports and paid claims, applies applicable CMS and NAIC guidance, and considers provider contracts, vendor agreements, medical policies, statutes, and reimbursement methodologies. The role also includes preparing and evaluating responses to client disputes. The specialist is expected to meet productivity and quality standards, maintain regular and predictable attendance, and follow Cotiviti policies, procedures, regulatory requirements, and HIPAA requirements. The position requires a dedicated secure work area and high-speed internet access. No adverse environmental conditions are expected.

Requirements

High school diploma required.
Bachelor’s degree preferred and/or at least 1–2 years of related healthcare experience.
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 effectively individually and as part of a team, with self-motivation to deliver results.
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 repetitive motions that may involve the wrists, hands, and/or fingers.
Ability to provide a dedicated, secure work area and high-speed internet access, including office setup and maintenance.
Commitment to Cotiviti Core Values, Strategic Pillars, and Operations Disciplines.

Nice To Haves

Healthcare industry experience, including knowledge of Coordination of Benefits.
One to two years of Cotiviti experience is recommended for internal candidates seeking their next opportunity.

Responsibilities

Audit client data and identify recovery claims, voids, and other over- or underpayment types.
Document relevant facts, information, and conclusions to support work performed and validate claims.
Communicate audit recommendations to the supervisory auditor for evaluation, verification, and continued learning.
Build and maintain a basic understanding of CMS and NAIC guidelines to establish the correct order of liability.
Use Cotiviti audit tools, including Recovery Management System (RMS), client systems, and Microsoft Excel to complete audits and review simple-to-medium proprietary reports.
Audit standard reports and paid claims to identify overpayments and underpayments across assigned audit concepts.
Meet or exceed productivity, attendance, quality, and production standards for assigned work.
Prepare and evaluate responses to client disputes, internally and externally, as needed.
Review client transactions and build proficiency with provider contracts and vendor agreements.
Make recommendations concerning medical policy applications, state and federal statutes, and reimbursement methodologies as applicable to the audit concept.
Maintain confidentiality and security of data and comply with HIPAA requirements, Cotiviti policies and procedures, and external regulatory requirements.
Demonstrate safe work practices and compliance with applicable industry standards.

Benefits

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance
401(k) savings plan
Paid family leave
Nine paid holidays per year
17–27 days of paid time off per year, depending on level and length of service
Eligibility for discretionary bonus consideration
Overtime pay for eligible nonexempt employees for hours worked over 40 in a week, or as required by applicable state law