Payment Accuracy Specialist

Cotiviti

. Develop new and existing audit concepts .

Posted 11/11/2026full-timeRemote • United StatesMid-LevelSenior💰 $29 - $33 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing concepts, data analysis, and compliance with CMS and NAIC guidelines. Proficient in utilizing audit tools and methodologies to identify discrepancies and recover claims while mentoring team members and ensuring adherence to industry standards.

Highest-signal resume keywords

Audit Concept DevelopmentData AnalysisSQL ProficiencyHealthcare Industry ExperienceTraining and Mentoring

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit ProceduresData MiningClaim AdjudicationContract ComplianceProvider BillingDuplicate Payment ReviewsPolicy AnalysisReimbursement MethodologyCustom Query DevelopmentReport Validation

Soft Skills

Verbal CommunicationWritten CommunicationCritical ThinkingProblem-SolvingTime Management

Tools & Technologies

Cotiviti Audit ToolsRecovery Management System (RMS)Microsoft ExcelMicrosoft OfficeDatabases

Industry Keywords

HealthcareClaim AdjustmentsProvider ContractsPayment IntegrityHIPAA Compliance

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Develop new and existing audit concepts
Gain client acceptance for audit concepts
Train all Specialist levels to execute audit projects
Evaluate the effectiveness of audit concepts
Audit client data and generate recoverable claims
Conduct and train more complex audit projects with limited supervision
Mentor, train, and develop less-tenured team members
Apply CMS and NAIC guidelines to establish the correct order of liability
Use Cotiviti audit tools, Recovery Management System (RMS), client systems, Microsoft Excel, and proprietary reports
Perform audit procedures involving issue identification, criteria development, evidence review, and analysis
Conduct audits across Data Mining, Claim Adjudication, Contract Compliance, Provider Billing, Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance
Analyze paid claims and document audit findings for training and knowledge sharing
Work with Engineering to improve tool and reporting efficiency
Update reports, develop and run custom queries, and validate report accuracy
Determine recovery likelihood based on client contract terms
Meet productivity and quality standards for assigned audits
Respond to inquiries and disputes regarding written claims and provide claim validation
Review transaction types, vendor agreements, client contracts, and data to identify potential overpayments or underpayments
Recommend medical policy, statutory, and reimbursement methodology applications
Onboard new hires and train existing staff on new concepts and processes
Research and substantiate new claim types and audit concept expansions
Recommend new concepts, processes, reports, tool functionality, and process improvements
Collaborate with Engineering on reports and tool functionality
Follow Cotiviti policies, procedures, and external regulatory requirements

Requirements

What you’ll need

High School Diploma - Required
Bachelor’s degree preferred and/or a minimum of at least 4–6 years related experience in healthcare
Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity
Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access)
Previous SQL experience strongly preferred
Excellent verbal and written communication skills
Strong interest in working with large data sets and various databases
Ability to work well in an individual and team environment
Ability to analyze large volumes of data and identify trends, discrepancies, and anomalies
Exceptional attention to detail
Strong critical thinking and practical problem-solving skills
Ability to make informed decisions based on data, regulations, and auditing standards
Strong understanding of auditing standards, regulations, and industry best practices
Ability to recognize issues requiring further investigation
Strong time management skills
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
Must ensure confidentiality and security of data in compliance with HIPAA laws and requirements

Benefits

Comp & perks

Discretionary bonus consideration
Overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law
Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17–27 days of Paid Time Off (PTO) per year, depending on specific level and length of service