Employer: Cotiviti
The Specialist I, Payment Accuracy position is responsible for auditing client data on behalf of Cotiviti’s clients and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for conducting or assisting in the identification, validation and documentation of moderate to more complex audit projects. Primarily responsible for auditing efforts by executing more independent projects, low to mid range in scope assigned by the Audit Manager.
- Identify and Enter Claims. Utilizes healthcare 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. Identify and validate over and under payments of claims. Work is moderate in scope and complexity. Knowledge is applied to resolve routine issues, as necessary. Scope may include: auditing paid transactions; determining whether an overpayment exists; identifying incorrect deductions; data mining. Enters the claim into Cotiviti system accurately and in accordance with standard procedures. Identify and discuss audit findings with audit team and document exceptions.
- Effectively Utilize Audit Tools. Utilize and demonstrate with consistency, Cotiviti and client tools required to perform duties. Enter the claim into Cotiviti system accurately and in accordance with standard procedures. Upon proficiency with systems tools, may update current reports, develops and runs custom queries and validate accuracy of current reports used. Make determinations based on prior knowledge, experience of client contract terms with the likelihood of recovery acceptance.
- Meet or Exceed Standards/Guidelines for Productivity. In addition to regular and predictable attendance, maintain production goals and quality standards set by the audit for the auditing concept. Audits against the standard expected level of quality and quantity (i.e. fees per hour, vendor/project volume completion, claims written).
- Meet or Exceed Standards/Guidelines for Quality. Achieve the standard level of quality set by the audit for the auditing concept, for valid claim identification and documentation. Contributes in decisions on audit work completed after the various possibilities have been considered.
- Prepare Response to Client and Supplier Disputes. Respond to client/Supplier disputes for claims written. Provide verification of claims validation and confirmation, in a concise written manner.
- New Hire Support. Participate in the on-boarding of employees new to the audit. Prepared to review audit tools, client specific terminology and people resources including colleagues, clients, and other stakeholders.
- Recommend New Concepts and Processes. Leverages knowledge of client, contract terms and complex claim types. Works towards developing and implementing new ideas approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction. Evaluates information and draws logical conclusions. Uses learned, tried and proven validation methods to test and produce a desired or intended result of the new concepts. May collaborate with Business Optimization in developing new reports.
Experience Requirements
- One (1) year of Cotiviti direct audit experience OR two (2) years related experience (healthcare billing, healthcare/medical claims, reimbursement, analytics) required;
- Strong working knowledge and understanding of healthcare industries preferred.
- Proven analytic experience using Microsoft Excel, Access database query capabilities and ability to assess data at various levels of detail.
- Investigative skills, including the ability to evaluate facts and evidences to draw conclusions, even if information is limited as well as explain problems or situations using a systematic framework
- Strong communication skills, including ability to build relationships and articulate thoughts clearly and effectively.
- Ability to succeed in a frequently changing and unstructured environment and deal with ambiguity.
- Team player that works collaboratively with various team members to accomplish integrated solutions.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities