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Cotiviti · 3 weeks ago

Payment Integrity Specialist

United States

Full-time

Remote

Mid, Senior Level

5+ years exp

Cotiviti is a company that provides claims audit and recovery services to private health insurers. The Payment Integrity Specialist plays a crucial role in auditing healthcare claims, reviewing clinical documentation, and supporting business development activities to enhance compliance solutions.

Responsibilities

Audit healthcare claims on behalf of our private health insurance clients to detect and recover overpayment

Review clinical documentations submitted by providers

Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover overpayments

Support the growth of the Payment Integrity Practice by supporting business development activities

Strictly respect the confidentiality of all sensitive company and client information

Qualification

Clinical codingAuditing private hospital claimsHealth Information ManagerHealth insurance legislation3M codefinderCommunication skillsTime managementOrganizational skills

Required

Experience in auditing private hospital claims

Understanding of private health insurance legislation and private hospital funding models

Experience working in the private health insurance sector or in private hospital audit

Excellent written and verbal communication skills

Effective time management, planning and organizational skills

Maintain knowledge and expertise by attending appropriate educational sessions

Ability to work remotely from home office

Preferred

Bachelor's Degree (Nursing or equivalent) with experience in Critical care, emergency department or operating theatre experience preferred

Health Information Manager

Clinical coder with a coding qualification with 5-8 years' experience

Clinical coding experience highly desired

Familiarity with 3M codefinder

Company

Cotiviti

Glassdoor3.7

Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.

Founded in 1979

South Jordan, UT, US

5001-10000 employees

http://www.cotiviti.com

H1B Sponsorship

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