About this role
The Payment Accuracy Specialist 2 role performs audits and develops new audit concepts within Cotiviti's Data Mining BU, focusing on claims recovery and compliance with CMS/NAIC guidelines.
Key Responsibilities
- Audit data and develop audit concepts
- Train staff
- Maintain productivity and quality standards
- Collaborate with Engineering to enhance tools
- Ensure HIPAA confidentiality
Technical Overview
Advanced data auditing with RMS, CMS/NAIC guidelines, SQL and Excel-based analysis, data-driven criteria development, and collaboration with engineering for tool improvements.
Ideal Candidate
The ideal candidate is a healthcare data auditor with 3-4 years of Cotiviti experience, strong SQL and Excel skills, and the ability to work independently on CMS/NAIC-guided audits to recover payments.
Must-Have Skills
High School Diploma - Required.Bachelor’s degree (Preferred) and/or a minimum of at least (4 - 6) year/s related experience in healthcare.At least 3 - 4 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally.Healthcare industry experienceincluding knowledge of claim adjustmentsprovider contractsreimbursement policies and payment integrity. (strongly preferred).Computer proficiency including Microsoft Office (WordExcelOutlookAccess).Previous SQL experience strongly preferred.Excellent verbal and written communication skills.Strong interest in working with large data sets and various databases.
Nice-to-Have Skills
Healthcare data experienceSQL experienceData mining experienceExperience with client contracts/vendor agreementsHIPAA knowledge
Tools & Platforms
Recovery Management System (RMS)Microsoft ExcelSQL
Required Skills
High School Diploma - RequiredBachelor’s degree (Preferred) and/or a minimum of at least 4-6 years related experience in healthcareAt least 3-4 year/s of Cotiviti experienceHealthcare industry experienceMicrosoft Office (WordExcelOutlookAccess)Previous SQL experience
Hard Skills
SQLMicrosoft ExcelRecovery Management System (RMS)CMS guidelinesNAIC guidelinesdata miningclaim adjudicationcontract complianceprovider billingduplicate payment reviewspolicy & reimbursement analysisreimbursement analysisHIPAA
Soft Skills
verbal and written communicationattention to detailteam environmentself-motivationprofessional skepticismcollaboration
Keywords for Your Resume
CotivitiPayment Accuracy Specialist 2Data MiningCMS guidelinesNAIC guidelinesRecovery Management System (RMS)Microsoft ExcelSQLclaim adjudicationcontract complianceprovider billingDuplicate Payment ReviewsPolicy & Reimbursement AnalysisReimbursement AnalysisHIPAAHealthcareremotedata setsonboardingRMS
Deal Breakers
No SQL experience, No healthcare experience, No high school diploma, Inability to work remotely
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