Team Lead, Payment Accuracy (Data Mining)

Cotiviti

7d • $80,000 - $95,000 • Remote

About The Position

Cotiviti Healthcare is the payment accuracy expert! We work with healthcare organizations to recover money, improve processes, strengthen relationships and maximize their value. As we continue to grow, we are seeking experienced Payment Accuracy Specialists to join our team. This is a great opportunity to join a well-established company with competitive pay, opportunities to develop professionally and excellent benefits.
This is a Senior Payment Accuracy Specialist with responsibility for leading or supervising a team within an audit engagement and is considered a mentor, trainer, developer of less tenured Audit team members. As a successful Payment Accuracy Specialist you will identify, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on your industry experience, regulatory research, and your ability to analyze medical claim data to discover incorrect payments. You will be responsible for analyzing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. You will assist in the identification, validation and documentation of moderate to more complex recovery projects. You will also be responsible for executing more independent projects assigned by your Operations Manager. If you are successful at thinking “outside of the box”, very analytical and love problem/puzzle solving complex medical claims, then look no further, review the position and requirements below and apply now!

Requirements

• Bachelor’s Degree preferred
• 4+ year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician Claims required
• Excellent communication skills both oral and written
• Strong interpersonal skills that will support collaborative team work
• Microsoft Office Proficient: Word and Excel; Access – highly preferred
• Occasional Travel (5% - 10%) as directed by Senior Leadership.
• 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.
• No adverse environmental conditions expected.

Nice To Haves

• Certified Professional / Hospital Coder Certification (CCS, CPC, CPC-H, CCS-P, CCRC, CCS-A, RHIA, RHIT ) preferred
• Prior claims auditing or consulting experience desirable in either a provider or payer environment

Responsibilities

• Utilizing healthcare experience to perform audit recovery procedures
• Identifying and validating incorrect claim payments
• Identifying and defining issues, developing criteria, reviewing and analyzing contracts and Health Plan reimbursement regulations
• Entering and documenting the incorrect payment issue into Cotiviti’s systems accurately and in accordance with standard procedures
• Updating and developing new and current audit recovery reports, developing and running custom queries
• Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Benefits

• Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees