Payment Accuracy Specialist 1

About the role

Cotiviti Healthcare is seeking a Payment Accuracy Specialist 1 to join our healthcare recovery team. This role is part of the Data Mining Business Unit and involves auditing client data to generate recoverable claims.

Responsibilities

• Conduct or assist in the identification, validation, and documentation of audit projects.
• Document relevant facts, information, and conclusions to support the work performed.
• Utilize information to share knowledge within the audit team.
• Build and maintain a solid understanding of CMS and NAIC guidelines.
• Proficiently use Cotiviti audit tools and client systems to complete auditing and review reports.
• Audit standard reports and paid claims to identify over and under-payments.
• Enter overpayments accurately into the Cotiviti system.
• Discuss audit findings with the audit team and suggest improvements.
• Update and develop custom queries and validate report accuracy.
• Make determinations based on client contract terms and recovery acceptance.
• Meet or exceed productivity and quality standards.
• Identify and research new claim types and suggest process improvements.
• Evaluate information and draw logical conclusions to implement new concepts.
• Collaborate with Engineering in the development of new reports.
• Ensure confidentiality and adhere to regulatory requirements.
• Work safely and comply with industry standards.

Qualifications

• High School Diploma
• Bachelor’s degree Preferred
• At least 2-4 years of related experience in healthcare
• At least 2-3 years of Cotiviti experience recommended
• Knowledge of Medicaid Claims strongly preferred
• Computer proficiency including Microsoft Office
• 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