[Remote] Senior Payment Accuracy Specialist

Note: The job is a remote job and is open to candidates in USA. Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. The Senior Payment Accuracy Specialist is responsible for developing new and existing audit concepts and training audit teams to execute audit projects effectively. The role aims to generate high-quality recoverable claims for the benefit of Cotiviti and its clients while also mentoring 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. 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)
• Prepares Responses to Client Disputes. Provides oversight to audit team for verification of 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
• Reviews provider Contracts. 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 to audit and client new claims and concept effectiveness. Ensures that any new and existing concepts are achieving desired goals in terms of recoveries, collectability and client acceptance
• 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. May participate in auditor assessment, progression process, staffing functions
• QA Claim Association/Concepts. Responsible for performing quality control process. 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

Skills

• 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
• Excellent verbal and written communication skills
• Ability to work well in an individual and team environment
• Prior Healthcare Billing and/or claims experience desired. Requires working knowledge of and applicable industry based standards

Benefits

• Medical
• Dental
• Vision
• Disability
• Life insurance coverage
• 401(k) savings plans
• Paid family leave
• 9 paid holidays per year
• 17-27 days of Paid Time Off (PTO) per year

Company Overview

• Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is http://www.cotiviti.com.

Company H1B Sponsorship

• Cotiviti has a track record of offering H1B sponsorships, with 165 in 2025, 118 in 2024, 90 in 2023, 102 in 2022, 72 in 2021, 67 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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