Payment Accuracy Specialist* at Cotiviti in Remote

Summary: Cotiviti is a company specializing in healthcare data analytics, and they are seeking a Payment Accuracy Specialist to join their Data Mining team. The role involves auditing client data to identify billing compliance issues and generating recoverable claims while maintaining productivity and quality standards. Responsibilities: - Auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients - Identifies and inputs recovery claims, voids, or other over-underpayment types - Documents relevant facts, information and conclusions drawn to support the work performed and validate the claim - Communicates audit recommendations to the supervisory auditor for evaluation, verification, and continuous learning - Displays professional skepticism that enhances the work performed to achieve success in the position - 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 - 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 - 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 Required Qualifications: - 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 Qualifications: - 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) Required Skills: Healthcare industry knowledge, Coordination of Benefits, Data mining, Audit tools - Recovery Management System (RMS), Microsoft Excel, Microsoft Word, Microsoft Outlook, Claims auditing, Regulatory compliance - HIPAA, Medical policy application, Contract compliance 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