[Hiring] Payment Accuracy Specialist 2 @Cotiviti

Role Description

Cotiviti Healthcare is seeking innovative thinkers and creative problem solvers for the role of Payment Accuracy Specialist 2. This role is part of the Data Mining Business Unit, responsible for developing audit concepts, training team members, and evaluating audit effectiveness.

• Works under moderate supervision, monitored for efficiency in production and quality review.
• Builds and maintains understanding of CMS and NAIC guidelines for liability order.
• Utilizes Cotiviti audit tools and Microsoft Excel for auditing and reporting.
• Performs audit procedures, identifying issues and analyzing evidence for medium and complex reports.
• Conducts advanced analysis of paid claims and identifies audit findings.
• Updates reports, develops custom queries, and validates report accuracy.
• Meets or exceeds productivity and quality standards for assigned work.
• Responds to inquiries and disputes on claims, providing verification and justification.
• Reviews transaction types and client contracts to identify over or underpayments.
• Onboards new hires and trains existing staff on new concepts.
• Identifies new claim types and recommends new concepts based on experience.
• Collaborates with Engineering for report and tool development.
• Ensures confidentiality and compliance with HIPAA laws.

Qualifications

• High School Diploma - Required.
• Bachelor’s degree (Preferred) and/or 4-6 years related experience in healthcare.
• 3-4 years of Cotiviti experience recommended for internal opportunities.
• Healthcare industry experience, knowledge of claim adjustments, provider contracts, and payment integrity (strongly preferred).
• Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access).
• Previous SQL experience strongly preferred.
• Excellent verbal and written communication skills.
• Strong interest in working with large data sets and databases.
• Ability to work well in individual and team environments.
• Understands and embodies Cotiviti Core Values and Operations Disciplines.

Requirements

• Ability to analyze large volumes of data and identify trends.
• Strong critical thinking skills to assess complex situations.
• Make informed decisions based on data and regulations.
• Strong understanding of auditing standards and industry best practices.
• Ability to recognize issues needing further investigation.
• Effective teamwork and collaboration skills.
• Strong time management skills to handle multiple tasks.

Benefits

• Competitive benefits package including medical, dental, vision, disability, and life insurance.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on level and service length.

Company Description

Cotiviti Healthcare is a leading provider of payment accuracy services to recognized companies in healthcare and retail industries.