Team Lead, Payment Accuracy (Data Mining)

Team Lead, Payment Accuracy (Data Mining)

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.

This is a 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 and apply now!

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

Qualifications

Mental Requirements

Physical Requirements and Working Conditions

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...

Equal Opportunity Employer Protected Veterans / Individuals with Disabilities