Senior Payment Accuracy Specialist – Healthcare
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior specialist developing and validating healthcare payment audits for Cotiviti’s payment accuracy services. Mentoring auditors, managing quality control, and generating recoverable claims.
Responsibilities:
- Develop new and existing healthcare payment audit concepts
- Gain client acceptance for audit concepts and expand concepts based on customer requirements
- Train audit staff to execute basic, intermediate, and complex audit projects
- Evaluate audit concept effectiveness and generate high-quality recoverable claims
- Conduct and document complex audit projects independently
- Assist Audit Managers with audit productivity, quality, and revenue goals
- Develop new reports, tools, processes, and technological improvements with Business Optimization and audit teams
- Own quality control by reviewing auditor claims before and after client submission
- Prepare responses to client disputes and oversee claim validation
- Review provider contracts and research medical policies and state and federal statutes
- Validate new claim types and audit concepts for recoveries, collectability, and client acceptance
- Mentor and develop less-tenured audit team members
- Perform QA claim association and ensure proper use of proprietary software, reports, and IT resources
Requirements:
- Bachelor's degree preferred
- Three (3) years of Cotiviti direct audit experience OR four (4) years of related experience in healthcare billing, healthcare/medical claims, reimbursement, or analytics
- Experience using SQL required
- Computer proficiency in Microsoft Excel, Access, and system databases required
- Ability to mentor staff and enhance auditor quality and productivity
- Prior healthcare billing and/or claims experience desired
- Working knowledge of applicable industry-based standards
- Excellent verbal and written communication skills
- Ability to work effectively independently and in a team environment
- Must provide a dedicated, secure work area
- Must provide high-speed internet access/connectivity and office setup and maintenance
Benefits:
- Discretionary bonus consideration
- Medical insurance
- Dental insurance
- Vision insurance
- Disability insurance
- Life insurance coverage
- 401(k) savings plan
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on level and length of service
- Overtime pay for nonexempt employees working more than 40 hours per week, or as required by applicable state law
- Career growth opportunities
Similar Jobs
Personal Care Specialist
Personal Care Specialist supporting pharmacy authorizations, insurance verification, and patient assistance for Cencora’s healthcare services. Managing patient inquiries and specialty pharmacy referrals on a 12-month contract.
Strategic Alliance PMO Lead
Remote Strategic Alliance PMO Lead coordinating Hitachi Energy’s commercial and operational partnerships across North America. Managing alliance governance, forecasting, capacity planning, and fulfillment execution.
Trust Specialist – UK Private Banking
Trust Specialist managing introducer and client relationships for Lloyds Banking Group’s UK Trust Services. Supporting Trust onboarding, customer guidance, and succession-planning growth remotely.
Senior VSL Specialist
Senior VSL Specialist owning Meta advertising, direct-response copy, and funnel performance. Helping Clients Blackbox generate qualified appointments for Registered Investment Advisors.
Mechanical Lead
Mechanical Lead overseeing cooling, piping, and commissioning readiness for OpenAI’s AI data center construction. Managing contractors, field delivery, testing, and operational handover.
Senior Technical Officer – Monitoring, Evaluation and Learning
Senior MEL Officer supporting FHI 360’s global health programs through data quality, evaluation, reporting, and adaptive learning. Providing technical backstopping focused on Democratic Republic of the Congo projects.
ATC – Full Time Tarde
Agente de atención al cliente remoto para Konecta, conectando empresas con sus clientes mediante agentes humanos e IA. Turno full time tarde desde Piura.
Senior Project Specialist – Payments Focus
Senior Payment Specialist managing site and participant payments for Syneos Health’s clinical-trial services. Coordinating financial reports, payment systems, vendors, and cross-functional stakeholders in Poland.
Site Contracts Lead
Site Contracts Lead supporting Syneos Health’s clinical research and life sciences services. Collaborating across drug development and commercialization to accelerate healthcare customer success.
Site Engagement Lead
Remote Site Engagement Lead accelerating patient recruitment and retention for ICON Strategic Solutions’ sponsor-dedicated clinical trials. Educating sites and analyzing performance to improve enrollment.
Site Engagement Lead
Site Engagement Lead accelerating patient recruitment and retention for ICON’s sponsor-dedicated clinical-trial programs. Educating sites, analyzing performance, and partnering with referral networks.
PT DRG Appeals Specialist
Part-time DRG Appeals Specialist conducting quality audits and client call coverage. Preparing DRG appeal submissions to support healthcare reimbursement solutions.
Leave & Accommodation Specialist
Leave and accommodation specialist administering FMLA, ADA, and multi-state leave programs. Supporting employees, managers, payroll, and HR compliance at Ideal Option.
Senior Telecom Transition Coordinator
Senior telecommunications transition coordinator managing DoD circuit migrations, TSRs, and cutovers. Supporting government customers and vendors through legacy-contract transitions.
Telecom Transition Coordinator – Mid Level
Telecommunications transition coordinator managing DoD circuit and service migrations for Mastech. Validating inventories, preparing TSRs, coordinating cutovers, and supporting government customers.
Continence Care Specialist
Convatec Continence Care Specialist driving continence product adoption across South UK clinical accounts. Delivering stakeholder education, formulary implementation, evaluations, and territory growth.
Medical Order Specialist
Medical Order Specialist processing patient order changes for Aveanna’s homecare services. Validating prescriptions, insurance authorizations, and HIPAA-compliant documentation remotely.
High Voltage Equipment Specialist
High-voltage equipment specialist supporting DEPCOM Power’s solar, storage, substation, and transmission projects. Owning equipment standards, BOMs, technical evaluations, and engineering support.
Uninsured Recovery Specialist
Remote Recovery Specialist managing uninsured and contractual claims for a rental vehicle company. Investigating losses, negotiating settlements, and monitoring payment plans.
Coding Coordinator
PB Coding Coordinator reviewing Epic billing edits and assigning medical codes for Intermountain Health. Supporting provider education, audits, and specialty coding compliance remotely.