[Hiring] Payment Accuracy Data Mining Specialist 2 @Cotiviti

Role Description

A Payment Accuracy 2, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). The Specialist 2, Payment Accuracy is responsible for developing new and existing audit concepts, gaining client acceptance, training all Specialist levels to execute audit projects, and evaluating the effectiveness of audit concepts.

• Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
• Conducts and trains more complex audit projects with some to limited supervision.
• Considered a mentor, trainer, and developer of less-tenured team members.
• Displays a high degree of independent judgment and professional skepticism.

Responsibilities

• Works under moderate supervision and is monitored for efficiency in production and quality review of assigned work.
• Builds and maintains a basic understanding of CMS and NAIC guidelines to establish the correct order of liability.
• Advanced with Cotiviti audit tools (Recovery Management System, specific client systems) to complete auditing and review reports.
• Utilizes healthcare experience to perform audit procedures including identifying and defining issues, developing criteria, and reviewing evidence.
• Conducts advanced analysis of paid claims and identifies audit findings.
• Works with Engineering to increase the efficiency of tools and reporting.
• May update current reports, develop and run custom queries, and validate the accuracy of current reports.
• Meets or exceeds standards for productivity and quality.
• Highly proficient in responding to inquiries and disputes on all claims written.
• Demonstrates aptitude in reviewing transaction types, client contracts, and client data.
• Identifies new claim types and concept expansion using proven methodologies.
• Recommends new concepts and processes based on experience and knowledge of client contract terms.
• Collaborates with Engineering in the development of new reports and tool functionality.
• Ensures 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 4-6 years related experience in healthcare.
• At least 3-4 years of Cotiviti experience is 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, Access).
• 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.
• 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 $29.00 to $33.00 an 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, and 17-27 days of Paid Time Off (PTO) per year.