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Cotiviti · 18 hours ago

Senior Payment Accuracy Specialist (Healthcare)

United States

Full-time

Remote

Mid, Senior Level

$36.50/hr - $39/hr

3+ years exp

Cotiviti Healthcare is a leading provider of payment accuracy services in the healthcare and retail industries. They are seeking a Senior Payment Accuracy Specialist responsible for developing audit concepts, training audit teams, and ensuring quality control for audit projects to improve healthcare payment integrity.

Responsibilities

Generates and Develops New Audit Concepts. Utilizes healthcare and auditing experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing and analyzing evidence with the intent to audit standard medium and complex reports. Leader in concept development across multiple audit verticals. This includes specifying the concept, interact with client to test and gain acceptance. Will execute on the expansion of the concept based on customer requirements. Focused on growing concept approval

Develops New Tools and Processes. Collaborates with Business Optimization and audit team in developing new reports. Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction

Directs ownership for Quality Control. Reviews all level auditor claims prior to and after client submission. Set by the audit: for the auditing concept, audit against the expected level of quality and quantity (i.e.; hit rate, # claims written, ID per hour)

Prepares Responses to Client Disputes. Provides oversight to audit team for verification of claims validation, insurance or employer validation in concise written or oral manner. Makes determinations based on advanced experience of client knowledge of contract terms, likelihood of acceptance recovery

Reviews provider Contracts. Subject matter expert in contracts and research requirements. Implements recommendations on contracts to fit projects within standard reports such as medical policies, state and federal statutes

Validates New Claim Types. With proficiency, utilizes audit tools to evaluate, document and validate to audit and client new claims and concept effectiveness. Ensures that any new and existing concepts are achieving desired goals in terms of recoveries, collectability and client acceptance

Auditor Development. Key participants in the development of audit staff. Actively trains audit team to execute basic, intermediate and complex audit projects with focus on new and existing audit concepts. May participate in auditor assessment, progression process, staffing functions

QA Claim Association/Concepts. Responsible for performing quality control process. Makes determinations based on advanced expertise and comprehension (knowledge) of claim categories, claim types. Ensures submission and execution of quality work, proper use of available proprietary software, reports and IT resources to conduct audits

Qualification

DatameerSQLHealthcare BillingMicrosoft ExcelMicrosoft AccessMentoringCommunication SkillsTeamwork

Required

Bachelor's degree preferred Three (3) years of Cotiviti direct audit experience OR four (4) years related experience (healthcare billing, healthcare/medical claims, reimbursement, analytics) required

Experience using Datameer and SQL required

Computer proficiency in Microsoft Excel, Access and system databases are required

Ability to mentor staff and enhance performance as it relates to the quality and productivity of their auditors

Excellent verbal and written communication skills

Ability to work well in an individual and team environment

Preferred

Prior Healthcare Billing and/or claims experience desired. Requires working knowledge of and applicable industry based standards

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

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