Team Lead, Payment Accuracy (Data Mining)

Cotiviti • Remote,

10d • $82,000 - $97,000 • Remote

About The Position

Cotiviti Healthcare is the payment accuracy expert, working with healthcare organizations to recover money, improve processes, strengthen relationships, and maximize their value. As the company continues to grow, they are seeking experienced Payment Accuracy Specialists to join the team. This is a Senior Payment Accuracy Specialist role with responsibility for leading or supervising a team within an audit engagement, serving as a mentor, trainer, and developer for less experienced Audit team members. The successful candidate will identify, develop, and implement new concepts to recognize incorrect payments, based on industry experience, regulatory research, and analysis of medical claim data. Responsibilities include analyzing client data, generating high-quality recoverable claims, assisting in the identification, validation, and documentation of moderate to complex recovery projects, and executing independent projects assigned by the Operations Manager. This role is ideal for individuals who excel at thinking outside the box, are highly analytical, and enjoy solving complex medical claim puzzles.

Requirements

• Bachelor’s Degree preferred
• 4+ year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician Claims required
• 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
• 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 )
• Prior claims auditing or consulting experience desirable in either a provider or payer environment
• Access proficiency

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

• 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, depending on specific level and length of service with Cotiviti

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level