Senior Payment Accuracy Specialist (Healthcare)

Cotiviti•Remote,

1d•$38 - $40•Remote

About The Position

Cotiviti Healthcare is seeking a Senior Payment Accuracy Specialist to support its healthcare recovery team and improve healthcare payment integrity. The role develops new and existing audit concepts, gains client acceptance, trains auditors at all levels, and evaluates audit effectiveness to generate high-quality recoverable claims for Cotiviti and its clients. The specialist independently conducts and documents complex audit projects, may have supervisory responsibilities, and assists Audit Managers with productivity, quality, and revenue goals. The role also mentors and develops less-tenured audit team members. The position involves developing audit concepts and tools, overseeing quality control, preparing responses to client disputes, reviewing provider contracts, validating new claim types and concepts, and developing audit staff. It requires healthcare audit experience, SQL, proficiency with Microsoft Excel, Access, and system databases, and the ability to work independently and collaboratively. The position requires a dedicated, secure work area, high-speed internet, and an office setup and maintenance. No adverse environmental conditions are expected. Base compensation ranges from $37.75 to $40.25 per hour. Specific offers depend on factors including experience, education, skills, certifications, and business needs. The role is eligible for discretionary bonus consideration. Nonexempt employees are eligible for overtime pay for hours worked in excess of 40 per week, or as required by applicable state law.

Requirements

Three years of direct Cotiviti audit experience or four years of related experience in healthcare billing, healthcare or medical claims, reimbursement, or analytics.
Experience using SQL.
Proficiency with Microsoft Excel, Access, and system databases.
Ability to mentor staff and improve auditor quality and productivity.
Excellent verbal and written communication skills.
Ability to work effectively in individual and team environments.
Working knowledge of applicable industry-based standards.
Ability to provide a dedicated, secure work area.
Ability to provide high-speed internet access/connectivity and office setup and maintenance.
Ability to communicate with others to exchange information and assess the accuracy, neatness, and thoroughness of assigned work.
Ability to remain stationary, often standing or sitting for prolonged periods, and perform repetitive motions involving the wrists, hands, and/or fingers.

Nice To Haves

Bachelor's degree preferred.
Prior healthcare billing and/or claims experience desired.

Responsibilities

Generate and develop new audit concepts, define audit issues and criteria, analyze evidence, and audit standard medium and complex reports.
Lead concept development across multiple audit verticals, specify concepts, work with clients to test and gain acceptance, and expand concepts according to customer requirements.
Collaborate with Business Optimization and audit teams to develop new reports, processes, and technological improvements that enhance audit production, communication, and client satisfaction.
Oversee quality control by reviewing claims from auditors at all levels before and after client submission, and assessing quality and productivity measures such as hit rate, claims written, and IDs per hour.
Provide oversight for verification of claims validation, insurance, or employer validation in response to client disputes; make determinations based on client knowledge, contract terms, and likelihood of recovery acceptance.
Review provider contracts and research requirements as a subject matter expert, and implement recommendations to align contracts with projects and standard reports, including medical policies and state and federal statutes.
Use audit tools to evaluate, document, and validate new claims and audit concepts, and ensure concepts meet recovery, collectability, and client-acceptance goals.
Train and develop audit staff to perform basic, intermediate, and complex projects, with a focus on new and existing audit concepts; may participate in auditor assessment, progression, and staffing.
Perform quality control of claim associations and concepts, ensuring quality submissions, appropriate use of proprietary software, reports, and IT resources, and accurate determinations based on claim-category and claim-type expertise.
Assist Audit Managers in managing audit productivity and achieving quality and revenue goals.

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 per year, depending on level and length of service
Discretionary bonus consideration
Overtime pay for eligible nonexempt employees for hours worked in excess of 40 per week, or as required by applicable state law