Back Office Representative

Job Description:

Audit client claims data and identify high quality overpayment claims

PRINCIPLE PURPOSE OF JOB

The Auditor position is an entry level position responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed so other reviewers may validate claim. Communicates audit recommendations to supervisory auditor for evaluation, verification and continuous learning. Also, Payment Accuracy Specialist is a position liable for reviewing the output of queries to identify overpayments.

JOB RESPONSIBILITIES

• Perform audits based on client’s policies and procedures and identify over payments
• Ensures compliance with established internal control procedures by examining operating procedures and related documentations
• Utilizes with increasing proficiency, proprietary reports, tools and systems required to perform duties with moderate guidance and direction
• Working proficiency with all systems and applications including internal and client tools
• Ensures timely completion of audit reports
• Courteous and responsive to client’s needs, meets or exceeds all client commitments
• Perform other duties and responsibilities per the process requirements as assigned`
• Calling Payers to collect the required information for Audit (Specific only to COB audits)

ATTRIBUTES AND BEHAVIORS

• Develop and maintains positive working relationships with others
• Shares ideas and information
• Assists colleagues unprompted
• Takes pride in the achievement of team objectives
• Has credibility with peers and senior managers
• Self-motivated – driven to achieve results
• Works with a sense of urgency
• Handles confidential information with sensitivity

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS

• Any Graduate
• Experience in US healthcare preferred. Freshers with good communication and analytical skills
• Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred
• Calling experience – Payers/Provider (Specific only to COB audits)

COMPETENCIES & JOB DEMANDS

• Good communication skills (written and verbal)
• Should be ready to work in different shifts, including night shift
• Ability to work independently under high pressured environment and meet deadlines
• Ability to work on multiple projects simultaneously
• Ability to work seated at a computer for long periods of time