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Do you have experience in the following?

  • Insurance Claims processing
  • Medical Billing and/or Coding

Does the following interest you?

  • A fast paced, casual work environment
  • Research and investigation of medical claims
  • Auditing medical claims for accuracy

If you answered yes to any of the above, we have an opportunity to join our team as an Insurance Claims Validator!

With this opportunity, you will gain valuable insurance claims experience through auditing medical claims to discover discrepancies related to insurance overpayments. You will research and investigate insurance claims in various systems, as well as audit claims for accuracy and eligibility. Once the claim is determined to be legitimate, records are updated accordingly. If fund recovery opportunities are identified, the claim record(s) are then sent to our fund’s recovery team for additional follow-up on behalf of the largest healthcare providers in the world.

Other responsibilities of the Insurance Claims Validator role include:

  • Identify and define claims errors and discrepancies
  • Review and analyze provider contracts and health plan reimbursement regulations
  • Update and develop new and current audit reports and develop and run custom queries
  • Working with a variety of claims including Medicare, Facility, In-patient, and Out-patient
  • Develop and implement new ideas that will help better recognize incorrect payments and generate a higher quality of recoverable claims
  • Meet or exceed department attendance and quality goals

What we offer:

  • Full-time, 40 hours per week, Monday through Friday, 8-5 pm schedule (Flexible schedule after completing a 4-week paid training program)
  • Full health, dental and vision insurance, STD/LTD, vacation, sick time, 401(k) with a company match, tuition reimbursement and more!
  • Career advancement opportunities
  • Competitive salary based on experience
  • Casual dress code

Applicant for this job will be expected to meet the following minimum qualifications:

Education

  • Must be 18 years or older
  • High School Diploma or GED required

Experience

  • 1-year experience in medical insurance claim processing, auditing, medical coding or related experience preferred or prior experience with EOBs, Provider/Member contracts, COBs, ICD 9/10, CMS Coding, etc.
  • Experience using general office software such as Outlook, Word and Excel

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Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.

We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support retail and life/legal industries with data management and recovery audit services.

Cotiviti applies deep data science and market expertise to help healthcare organizations in three critical areas:

·        Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are paid appropriately

·        Risk Adjustment: ensuring that health plans accurately capture and report how sick their members are so that plans are appropriately reimbursed for the healthcare services their members receive

·        Quality and Performance: evaluating healthcare cost, quality, and utilization at individual, provider, and population levels to identify the best opportunities for financial and clinical performance improvement