Payment Integrity Specialist

1 week ago

Sydney, Australia Cotiviti Full time

Overview:
The Payment Integrity Specialist provides outsourced claims audit and recovery services to private health insurer clients using HIBIS leakage detection software and provide expert feedback to improve Cotiviti Australia solutions.

**Responsibilities**:

- Deliver value to clients by using HIBIS to detect and recover claims leakage
- Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover leakage
- Improve HIBIS rule yield by recommending new and/or improved rules
- Support the growth of the Recoveries Service by supporting business development activities
- Strictly respect the confidentiality of all sensitive company and client information
- 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:

- Bachelor’s Degree (Nursing or equivalent)
- 5-8 years’ experience with hospital claim review
- Familiarity with hospital coding
- Ability to provide clinical advice for claim reviews
- Understanding of private hospital funding models
- Accurate and timely analysis of HIBIS alerts
- Excellent written and verbal communication skills
- Effective time management, planning and organisational skills
- Maintain knowledge and expertise by attending appropriate educational sessions
- Ability to work hybrid conditions (in office and remotely from home office)

**Working Conditions and Physical Requirements**:

- Remaining in a stationary position, often standing or sitting for prolonged periods.
- Communicating with others to exchange information.
- Repeating motions that may include the wrists, hands and/or fingers.
- Assessing the accuracy, neatness and thoroughness of the work assigned.
- No adverse environmental conditions expected

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