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Cotiviti · 2 days ago

Payment Accuracy Specialist 2

United States

Full-time

Remote

Mid Level

$29/hr - $33/hr

4+ years exp

Cotiviti Healthcare is a leading provider of payment accuracy services to the healthcare and retail industries. The Payment Accuracy Specialist 2 is responsible for developing audit concepts, training team members, and conducting audits to ensure compliance and recoverable claims for clients.

Information Technology & Services

H1B Sponsor Likely

Responsibilities

This individual will work under moderate supervision and will be monitored for efficiency in production and quality review of assigned work

Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability

Advanced with Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, and have an expert understanding of Microsoft Excel and client applications

Utilizes healthcare experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing, and analyzing evidence with the intent to audit medium and complex reports. Work is advanced in scope and complexity. Knowledge is applied to resolve routine issues, as necessary. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance

Advanced analysis of paid claims and identification of audit findings including documentation for training and knowledge sharing. Works with Engineering to increase the efficiency of tools and reporting

May update current reports, develop and run custom queries, and validate the accuracy of current reports used. Makes determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance

Meets or Exceeds Standards for Productivity in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Achieves the expected level of quality and quantity for assigned work (i.e. hit rate, claims written, vendor/project volume completion, ID and/or fees per hour)

Meets or Exceeds Standards for Quality by Achieving the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation

Highly proficient, subject matter expert in responding to inquiries and disputes received on all claims written. Provides verification of claims validation and confirmation, in a concise written manner, utilizing facts and details for justification purposes

Demonstrates aptitude in reviewing transaction types, client contracts/vendor agreements, and client data with limited supervision of how to identify potential over or underpayments. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept

Considered a skilled resource in onboarding new hires and/or training existing staff on new concepts and processes

Identifies New Claim Types & Concept Expansion by using proven methodologies to research and substantiate claims outside the audit concept. Enlists others internally or externally to help validate, suggest, develop, and analyze high-quality, high-value concepts and/or process improvements, tool enhancements, etc. Strong driver and voice in the development of audit concepts

Recommends New Concepts & Processes based on experience and in-depth knowledge of client contract terms and complex claim types. Has a proven record of developing and implementing new ideas, approaches, and/or technological improvements that support and enhance audit production. Uses advanced validation methods to test and produce a desired/intended result of the new concept. Regularly collaborates with Engineering in the development of new reports and tool functionality

Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements

Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards

Qualification

Healthcare industry experienceSQLMicrosoft ExcelMicrosoft OfficeData analysisVerbal communicationWritten communicationTeamworkSelf-motivation

Required

High School Diploma - Required

Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access)

Excellent verbal and written communication skills

Strong interest in working with large data sets and various databases

Ability to work well in an individual and team environment demonstrating self–motivation to deliver success

Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally

Preferred

Bachelor's degree (Preferred) and/or a minimum of at least (4 - 6) year/s related experience in healthcare

At least 3 - 4 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally

Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity. (strongly preferred)

Previous SQL experience strongly preferred

Benefits

Medical

Dental

Vision

Disability

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

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

Cotiviti has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2025 (165)

2024 (118)

2023 (90)

2022 (102)

2021 (72)

2020 (67)