Payment Accuracy Data Mining Specialist 2 Job Locations

US-Remote ID

2024-13990

Category Audit - Healthcare  

Position Type Full-Time Overview

Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist 2. This role is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. The Specialist 2 is responsible for developing new and existing audit concepts, gaining client acceptance, training all Specialist levels to execute audit projects, and evaluating the effectiveness of audit concepts.  Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.  Conducts and trains more complex audit projects with some to limited supervision.  Considered a mentor, trainer, and developer of less-tenured team members.  Displays a high degree of independent judgment and professional skepticism that enhances the work performed in order to achieve success in the position.

Responsibilities

This individual will work under moderate supervision and will be monitored for efficiency in production and quality review of assigned work. * Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability. * Advanced with Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, has an expert understanding of Microsoft Excel and client applications * Utilizes healthcare experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing, and analyzing evidence with the intent to audit medium and complex reports. Work is advanced in scope and complexity.  Knowledge is applied to resolve routine issues, as necessary. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing and Duplicate Payment Reviews, Policy and Reimbursement Analysis, and Quality Assurance. * Advanced analysis of paid claims and identification of audit findings including documentation for training and knowledge sharing. Works with Engineering to increase the efficiency of tools and reporting. * May update current reports, develop and run custom queries and validate the accuracy of current reports used. Makes determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance. * Meets or Exceeds Standards for Productivity in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Achieves the expected level of quality and quantity for assigned work (i.e. hit rate, claims written, vendor/project volume completion, ID and/or fees per hour) * Meets or Exceeds Standards for Quality by Achieving the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation. * Highly proficient,... For full info follow applic ation link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities