Senior Payment Accuracy Specialist

Overview

Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Senior Payment Accuracy Specialist.

The Senior Payment Accuracy Specialist position is responsible for developing new and existing audit concepts, gaining client acceptance, training all audit levels to execute audit projects and evaluating the effectiveness of audit concepts. The goal of the position is to generate high quality recoverable claims for the benefit of Cotiviti and our clients. This role conducts and documents more complex audit projects independently and represents the most senior skill level, which may include supervisory responsibility. You will assist Audit Managers in managing audit productivity, achieving expected quality and revenue goals. This role is considered a mentor, trainer, and developer of less tenured Audit team members.

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. You will be a leader in concept development across multiple audit verticals, specifying concepts, interacting with clients to test and gain acceptance, and executing concept expansion based on customer requirements, focusing on growing concept approval.
• Develops New Tools and Processes: Collaborates with Business Optimization and the 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. Sets audit standards for the auditing concept, auditing against the expected level of quality and quantity (i.e., hit rate, number of claims written, ID per hour).
• Prepares Responses to Client Disputes: Provides oversight to the audit team for verification of claims validation, insurance or employer validation in a concise written or oral manner. Makes determinations based on advanced experience of client knowledge of contract terms and likelihood of acceptance recovery.
• Reviews Provider Contracts: Acts as a subject matter expert in contracts and research requirements. Implements recommendations on contracts to fit projects within standard reports such as medical policies, state, and federal statutes.
• Validates New Claim Types: With proficiency, utilizes audit tools to evaluate, document, and validate new claims and concept effectiveness for both audit and client. Ensures that any new and existing concepts are achieving desired goals in terms of recoveries, collectability, and client acceptance.
• Auditor Development: Plays a key participant role in the development of audit staff. Actively trains audit team to execute basic, intermediate, and complex audit projects with a focus on new and existing audit concepts. May participate in auditor assessment, progression process, and staffing functions.
• QA Claim Association/Concepts: Responsible for performing the quality control process. Makes determinations based on advanced expertise and comprehension of claim categories and 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.

Mental Requirements

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements And Working Conditions

• 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.

Key skills/competency

• Payment Accuracy
• Healthcare Auditing
• SQL
• Microsoft Excel
• Audit Concept Development
• Claims Processing
• Quality Control
• Client Relations
• Mentoring
• Contract Review