Cotiviti · 10 hours ago
Payment Accuracy Specialist*
United States
Full-time
Remote
Entry Level
$21/hr - $24/hr
1+ years expCotiviti is a company focused on data mining for healthcare billing compliance. The Payment Accuracy Data Mining Specialist is responsible for auditing client data and generating recoverable claims while ensuring adherence to regulatory guidelines.
Information Technology & Services
Responsibilities
This individual will work under direct 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
Utilizes Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, has a proficient understanding of Microsoft Excel and client applications
Audits standard reports and paid claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various clients. Assigned to simple - medium reports
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. Audits against the expected level of quality and quantity for assigned work (i.e. hit rate, number of claims written, Identification (ID) per hour)
Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation
Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed
Reviews client transactions by building personal proficiency around provider contracts and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept
Has a basic understanding of the healthcare industry, as well as proven track record of delivering results
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
Required
High School Diploma - Required
Computer proficiency including Microsoft office (Word, Excel, Outlook)
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
Preferred
Bachelor's degree (Preferred) and/or a minimum of at least one (1 -2) year/s related experience in healthcare
At least 1- 2 year/s Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Audit Support positions)
Healthcare industry experience, including knowledge of Coordination of Benefits. (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
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.
5001-10000 employees
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
Represents job field similar to this job
Trends of Total Sponsorships
2025 (165)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
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