Senior Payment Accuracy Team Lead — Audit & Recovery

Cotiviti; United States; On-site; USD 80,000 - 95,000; Full time

Job summary

Cotiviti Healthcare is the payment accuracy expert seeking experienced Payment Accuracy Specialists to join the team. The Senior Payment Accuracy Specialist will lead or supervise a team, audit recovery procedures, and identify incorrect claim payments to maximize recoveries for Cotiviti and clients.

The role requires strong analytical skills, experience with medical claim data, and the ability to develop documentation for complex recovery projects. Competitive benefits provided.

Qualifications

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

Responsibilities

• Utilizing healthcare experience to perform audit recovery procedures
• Identifying and validating incorrect claim payments
• Identifying and defining issues, developing criteria, reviewing and analyzing contracts and Health Plan reimbursement regulations
• 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
• Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Skills

Excellent communication skills

Strong interpersonal skills

Microsoft Word

Microsoft Excel

Microsoft Access

Education

Bachelor’s Degree preferred

Tools

Access

Job description

Cotiviti Healthcare is the payment accuracy expert seeking experienced Payment Accuracy Specialists to join the team. The Senior Payment Accuracy Specialist will lead or supervise a team, audit recovery procedures, and identify incorrect claim payments to maximize recoveries for Cotiviti and clients.

The role requires strong analytical skills, experience with medical claim data, and the ability to develop documentation for complex recovery projects. Competitive benefits provided.