Team Lead, Payment Accuracy (Data Mining)

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

Overview

Cotiviti Healthcare is the payment accuracy expert! We work with healthcare organizations to recover money, improve processes, strengthen relationships and maximize their value. As we continue to grow, we are seeking experienced Payment Accuracy Specialists 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.

Senior Payment Accuracy Specialist with responsibility for leading or supervising a team

within an audit engagement and is considered a mentor, trainer, developer of less tenured Audit team members. As a successful Payment Accuracy Specialist 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.

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

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

Qualifications

• Bachelor’s Degree preferred
• 4+ year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician Claims required
• 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

Mental Requirements:

• Occasional Travel (5% – 10%) as directed by Senior Leadership.
• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $80,000 to $95,000 per year. 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

Date of posting: 2/2/2026Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/2/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.