Payment Accuracy/Sql Specialist 2

Overview

Cotiviti Healthcare is the payment accuracy expert! We work with healthcare organizations to recover money, improve processes, strengthen relationships and maximize their value. We are a fast growing and highly successful payment integrity firm with a long history of success. As we continue to grow, we are seeking experienced Payment Accuracy Specialist II to join our team. This is a great opportunity to join a well-established company with competitive pay, opportunities to develop professionally and excellent benefits.

Responsibilities

As a successful Payment Accuracy Specialist II, you will identify, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on your industry experience, regulatory research, and your ability to analyze medical claim data to discover incorrect payments. You will be responsible for analyzing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. You will assist in the identification, validation and documentation of moderate to more complex recovery projects. You will also be responsible for executing more independent projects assigned by your Operations Manager. If you are successful at thinking “outside of the box”, very analytical and love problem/puzzle solving complex medical claims, then look no further, review the position and requirements below and apply now!

Other responsibilities of the Payment Accuracy Specialist II role include:

• Entering and documenting the incorrect payment issue into Cotiviti’s systems accurately and in accordance with standard procedures
• Updating and developing new and current audit recovery reports, developing and running custom queries
• Utilizing healthcare experience to perform audit recovery procedures
• Identifying and validating incorrect claim payments
• Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings
• Identifying and defining issues, developing criteria, reviewing and analyzing contracts and Health Plan reimbursement regulations

As a Payment Accuracy Specialist II - you must have a passion for solving complex medical claim reimbursement problems. You must be an independent thinker with a great attention to detail. You must be a self-disciplined team player who enjoys working in a collaborative environment. Qualified candidates have the ability to multitask, set priorities and meet deadlines.

Qualifications

• Medicare experience strong preferred
• Excellent communication skills both oral and written
• Microsoft Office Proficient: Word and Excel; Access – highly preferred
• Prior claims auditing or consulting experience desirable in either a provider or payer environment
• Bachelor’s Degree preferred
• Minimum 3 year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician claims or strong data analytics experience required
• Certified Professional / Hospital Coder Certification (CCS, CPC, CPC-H, CCS-P, CCRC, CCS-A, RHIA, RHIT ) preferred
• Strong interpersonal skills that will support collaborative team work

Base compensation ranges from $25.00 per hour to $35.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

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