Payment Accuracy Data Mining Specialist

As a Payment Accuracy Specialist, you will work under direct supervision and be monitored for efficiency in production and quality review of assigned work. You should have 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. The role utilizes Cotiviti audit tools and specific client systems to complete auditing, review simple - medium proprietary reports, and requires understanding of Microsoft Excel and client applications. Responsibilities also include auditing standard reports and paid claims to identify over and underpayments of claims across Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various clients.