- Identifies New Claim Types & Concept Expansion by researching and identifying potential claims outside the audit concept. Suggests, develops, and analyzes high quality, high value concepts and/or process improvements, tool enhancements, etc.
- Recommends New Concepts & Processes by leveraging knowledge of client, contract terms, and complex claim types. Works towards developing and implementing new ideas, approaches, and/or technological improvements that will support and enhance audit production. Evaluates information and draws logical conclusions. Uses learned, tried, and proven validation methods to test and produce the desired/intended result of the new concept. May collaborate with Engineering in the development of new reports
- Demonstrates understanding of Cotiviti policies & 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.
- Complete all responsibilities as outlined on annual Performance Plan.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
Qualifications
- High School Diploma – Required
- Bachelor’s degree (Preferred) and/or a minimum of at least (2 – 4) year/s related experience in healthcare.
- At least 2 – 3 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Audit Support positions).
- Healthcare industry experience, including knowledge of Coordination of Benefits. (Preferred).
- Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access)