Payment Accuracy Specialist

Job Summary:

The Specialist Payment Accuracy I is responsible for independently conducting complex audits on client systems, validating claim adjudications, and ensuring the accuracy and compliance practices. This role involves leading audit projects, calling multiple payers, providing actionable insights, and collaborating with management to enhance audit effectiveness and operational risk controls. The Specialist Payment Accuracy I documents detailed findings and develops recommendations to improve claim accuracy and determine primacy audit outcomes and ensure quality and consistency.

Principal Responsibilities and Essential Duties:

• Calling Multiple payers to capture the required information.
• Perform audits based on clients policies and procedures and identify over payments
• Ensures compliance with established internal control procedures by examining operating procedures and related documentations
• Collect accurate information and documents to proceed with a claim
• Make sure the overpayments for claims are accurate and correct by analyzing claims and supporting documentation
• Address assigned inventory to be compliant based on the client requirements.
• Utilization of all possible tools and applications available to take account to the next level of resolution.
• Meet the established SLAs (service level agreements) for production and quality
• Update the outcome of the work or analysis in a clear documentation.
• Utilize the process SOP and stay updated with changes done with the SOPs
• Improve the performance based on the feedback provided by the reporting manager / quality audit team
• Exhibit behavior consistent with Cotiviti Values
• Customer Driven
• Collaborative
• Accountable
• Open

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Required

Requirements:

• At least 2-3 years of relevant experience (auditing, claims, billing, reimbursement, data analysis)
• Bachelor’s degree required.
• Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred
• Strong interest in working with large data sets and various databases
• Healthcare industry experience desired
• Excellent verbal and written communication skills
• Self-motivated and driven to succeed
• Good Communication skills
• Must be ready to work night shifts
• Should be ready to work on multiple projects simultaneously

Cognitive / Mental Requirements:

• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

Physical Requirements and Working Conditions:

• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.
• Should be responsible in ensuring that data security is maintained at all times.