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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare payment audits, including the development and evaluation of audit concepts, while effectively mentoring audit staff and ensuring quality control. Proficient in SQL and Microsoft Excel, with a strong understanding of healthcare billing and claims processes.
Highest-signal resume keywords
Healthcare Payment Audit DevelopmentSQL ProficiencyMicrosoft Excel ExpertiseMentoring Audit StaffHealthcare Billing Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare Payment AuditSQLMicrosoft ExcelMicrosoft AccessAudit Project ManagementQuality ControlClaim ValidationData AnalysisReport DevelopmentAudit Concept Evaluation
Soft Skills
Excellent Communication SkillsTeam CollaborationIndependent Work AbilityMentoring SkillsProblem-Solving
Tools & Technologies
Proprietary SoftwareSystem DatabasesBusiness Optimization Tools
Industry Keywords
Healthcare BillingMedical ClaimsReimbursementAudit StandardsClient Dispute ResolutionState and Federal Statutes
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Develop new and existing healthcare payment audit concepts
- Gain client acceptance for audit concepts and expand concepts based on customer requirements
- Train audit staff to execute basic, intermediate, and complex audit projects
- Evaluate audit concept effectiveness and generate high-quality recoverable claims
- Conduct and document complex audit projects independently
- Assist Audit Managers with audit productivity, quality, and revenue goals
- Develop new reports, tools, processes, and technological improvements with Business Optimization and audit teams
- Own quality control by reviewing auditor claims before and after client submission
- Prepare responses to client disputes and oversee claim validation
- Review provider contracts and research medical policies and state and federal statutes
- Validate new claim types and audit concepts for recoveries, collectability, and client acceptance
- Mentor and develop less-tenured audit team members
- Perform QA claim association and ensure proper use of proprietary software, reports, and IT resources
Requirements
What you’ll need- Bachelor's degree preferred
- Three (3) years of Cotiviti direct audit experience OR four (4) years of related experience in healthcare billing, healthcare/medical claims, reimbursement, or analytics
- Experience using SQL required
- Computer proficiency in Microsoft Excel, Access, and system databases required
- Ability to mentor staff and enhance auditor quality and productivity
- Prior healthcare billing and/or claims experience desired
- Working knowledge of applicable industry-based standards
- Excellent verbal and written communication skills
- Ability to work effectively independently and in a team environment
- Must provide a dedicated, secure work area
- Must provide high-speed internet access/connectivity and office setup and maintenance
Benefits
Comp & perks- Discretionary bonus consideration
- Medical insurance
- Dental insurance
- Vision insurance
- Disability insurance
- Life insurance coverage
- 401(k) savings plan
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on level and length of service
- Overtime pay for nonexempt employees working more than 40 hours per week, or as required by applicable state law
- Career growth opportunities