Senior Payment Accuracy Specialist

Responsibilities

• Generates and Develops New Audit Concepts.
  • Utilizes healthcare and auditing experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing and analyzing evidence with the intent to audit standard medium and complex reports.
  • Leader in concept development across multiple audit verticals. This includes specifying the concept, interact with client to test and gain acceptance. Will execute on the expansion of the concept based on customer requirements. Focused on growing concept approval.
• Develops New Tools and Processes.
  • Collaborates with Business Optimization and audit team in developing new reports. Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction.
• Directs Ownership for Quality Control.
  • Reviews all level auditor claims prior to and after client submission. Set by the audit: for the auditing concept, audit against the expected level of quality and quantity (i.e.; hit rate, # claims written, ID per hour).
• Provides Oversight to Audit Team for Verification of Claims Validation.
  • Verifies claims validation, insurance or employer validation in concise written or oral manner. Makes determinations based on advanced experience of client knowledge of contract terms, likelihood of acceptance recovery.
• Validates New Claim Types.
  • With proficiency, utilizes audit tools to evaluate, document and validate to audit and client new claims and concept effectiveness.
• Auditor Development.
  • Key participants in the development of audit staff. Actively trains audit team to execute basic, intermediate and complex audit projects with focus on new and existing audit concepts.
  • Makes determinations based on advanced expertise and comprehension (knowledge) of claim categories, claim types. Ensures submission and execution of quality work, proper use of available proprietary software, reports and IT resources to conduct audits.

Qualifications

• Bachelor's degree preferred
• Three (3) years of Cotiviti direct audit experience OR four (4) years related experience (healthcare billing, healthcare/medical claims, reimbursement, analytics) required.
• Experience using SQL required.
• Computer proficiency in Microsoft Excel, Access and system databases are required.
• Ability to mentor staff and enhance performance as it relates to the quality and productivity of their auditors.
• Prior Healthcare Billing and/or claims experience desired.
• Requires working knowledge of and applicable industry based standards.
• Excellent verbal and written communication skills.
• Ability to work well in an individual and team environment.