Payment Accuracy Specialist

Role Description

A Payment Accuracy, Data Mining (DM) Specialist is responsible for auditing client data and generating high-quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, the specialist identifies and inputs recovery claims, voids, or other over-underpayment types. Key responsibilities include:

• Working under direct supervision and monitored for efficiency in production and quality review of assigned work.
• Building and maintaining a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines.
• Utilizing Cotiviti audit tools (Recovery Management System, specific client systems) to complete auditing and review simple to medium proprietary reports.
• Auditing standard reports and paid claims to identify over and underpayments of claims.
• Meeting or exceeding standards for productivity and quality set by the audit for the auditing concept.
• Preparing and evaluating responses to client disputes both internally and externally.
• Reviewing client transactions and making recommendations on medical policy applications and reimbursement methodologies.
• Ensuring confidentiality and security of all data, adhering to HIPAA laws and requirements.

Qualifications

• High School Diploma - Required.
• Bachelor’s degree (Preferred) and/or a minimum of at least one (1-2) year/s related experience in healthcare.
• At least 1-2 years of Cotiviti experience recommended for individuals seeking their next opportunity internally.
• Healthcare industry experience, including knowledge of Coordination of Benefits (Preferred).
• 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.
• Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines.

Requirements

• 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.
• Providing a dedicated, secure work area.
• Providing high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Benefits

• Base compensation ranges from $21.00 to $24.00 per hour.
• Eligible for discretionary bonus consideration.
• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week.
• 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.