Payment Accuracy Specialist

Payment Accuracy Specialist A Payment Accuracy, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. A Payment Accuracy Data Mining (DM) Specialist is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed and validate the claim. Communicates audit recommendations to the supervisory auditor for evaluation, verification, and continuous learning. Displays professional skepticism that enhances the work performed to achieve success in the position. Responsibilities: Works under direct supervision and will be monitored for efficiency in production and quality review of assigned work. Builds and maintains 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. Utilizes Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, has a proficient understanding of Microsoft Excel and client applications. Audits standard reports and paid claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing and Duplicate Payment Reviews, Policy and Reimbursement Analysis, and Quality Assurance across various clients. Assigned to simple - medium reports. Meets or exceeds standards for productivity, in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation. Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed. Reviews client transactions by building personal proficiency around provider contracts and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept. Has a basic understanding of the healthcare industry, as well as proven track record of delivering results. Demonstrates understanding of Cotiviti policies and procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards. 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 requirements... Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

Created: 2026-03-04