Payment Integrity Specialist

5 days ago

Sydney, Australia Cotiviti Full time

Overview:
Working as a part of our Payment Integrity Practice, the Payment Integrity Specialist provides claims audit and recovery services to our private health insurer clients and provide expert feedback to improve our compliance solutions.

**Responsibilities**:

- Assess healthcare claims on behalf of our private health insurance clients to detect and recover overpayment.
- Review clinical documentations submitted by providers
- Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover overpayments
- Support the growth of the Payment Integrity Practice 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) or HIMAA certification
- 5-8 years’ experience with hospital claim review
- Ability to provide clinical advice for claim reviews
- Clinical coding experience highly desired
- Health Information Manager certification desired
- Understanding of private hospital funding models
- Familiarity with 3M codefinder
- 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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