This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

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.
• Analyze client data and generate high quality recoverable claims for the benefit of Cotiviti and our clients.
• Assist in the identification, validation, and documentation of moderate to more complex recovery projects.
• Execute 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 review the position and requirements below and apply now!

• Utilize healthcare experience to perform audit recovery procedures.
• Identify and validate incorrect claim payments.
• Identify and define issues, develop criteria, review and analyze contracts and Health Plan reimbursement regulations.
• Enter and document the incorrect payment issue into Cotiviti’s systems accurately and in accordance with standard procedures.
• Update and develop new and current audit recovery reports, developing and running custom queries.
• Research reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.

Qualifications

• Bachelor’s Degree preferred.
• 4+ years of 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 teamwork.
• Microsoft Office Proficient: Word and Excel; Access – highly preferred.

Requirements

• 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.

Benefits

• Base compensation ranges from $80,000 to $95,000 per year.
• This role is eligible for discretionary bonus consideration.
• Cotiviti offers a competitive benefits package including 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.