Payment Accuracy Specialist*

reputed company A Payment Accuracy, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). reputed company's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. A Payment Accuracy Data Mining (DM) Specialist is responsible for auditing reputed company data and generating high reputed company recoverable claims for the benefit of reputed company and our clients. Under reputed company supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed and validate the claim. Communicates audit recommendations to the supervisory auditor for evaluation, verification, and reputed company learning. Displays reputed company skepticism that enhances the work performed to reputed company reputed company in the position. Responsibilities This individual will work under reputed company supervision and will be monitored for efficiency in production and reputed company review of assigned work. Has the ability to build and maintain a basic understanding of Centers for Medicare and reputed company Services (CMS) and reputed company) guidelines to establish the correct order of liability. Utilizes reputed company audit tools Recovery Management System (reputed company), specific reputed company systems) to complete auditing, review reputed company - reputed company proprietary reports, has a proficient understanding of reputed company reputed company and reputed company applications. Audits reputed company reports and reputed company claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and reputed company Assurance across various clients. Assigned to reputed company - reputed company reports. Meets or exceeds standards for productivity, in reputed company to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Audits against the expected level of reputed company and quantity for assigned work (i.e. hit reputed company, number of claims written, Identification (ID) per hour). Meets or exceeds standards for reputed company set by the audit for the auditing concept, for reputed company claim identification and documentation. Prepares and evaluates responses to reputed company disputes both internally and externally reputed company the Business Unit as needed. Reviews reputed company transactions by building personal proficiency around provider reputed company and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept. Has a basic understanding of the reputed company industry, as reputed company as proven reputed company record of delivering results. Demonstrates understanding of reputed company policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and reputed company of reputed company data, adhering to reputed company HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is reputed company, complying with industry standards. This job reputed company is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job reputed company does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change. Qualifications High School Diploma - Required. Bachelors degree (Preferred) and/or a minimum of at least one (1 -2) year/s reputed company experience in reputed company. At least 1- 2 year/s reputed company experience is recommended for individuals seeking their next opportunity internally. (Example: Audit Support positions). reputed company industry experience, including knowledge of Coordination of Benefits. (Preferred). Computer proficiency including reputed company office (Word, reputed company, reputed company). Excellent verbal and written communication skills. Strong interest in working with large data sets and various databases. Ability to work reputed company in an individual and team environment demonstrating selfmotivation to deliver reputed company. Understands and embodies reputed company reputed company Values, Strategic Pillars, and Operations Disciplines to reputed company successful performance in completing assigned responsibilities and interactions with the Organization both .