Payment Accuracy Specialist 2

Accountabilities Perform advanced healthcare payment audits by analyzing claims data, identifying discrepancies, and documenting valid recovery opportunities.

Develop, evaluate, and improve audit concepts focused on payment accuracy, contract compliance, reimbursement policies, provider billing, and claim adjudication.

Review complex reports, client data, contracts, and reimbursement methodologies to identify potential overpayments or underpayments.

Utilize audit platforms, reporting tools, databases, and advanced Microsoft Excel capabilities to conduct investigations and validate findings.

Create and maintain custom queries, reports, and audit workflows while collaborating with technical teams to improve tools and processes.

Ensure audit findings are accurate, well-documented, and supported with clear explanations for clients and internal stakeholders.

Respond to claim inquiries and disputes by providing detailed validation and professional written documentation.

Mentor and train less experienced team members, sharing knowledge, audit techniques, and best practices.

Identify opportunities for new audit concepts, process enhancements, automation improvements, and technology-driven efficiencies.

Maintain compliance with healthcare regulations, confidentiality requirements, and HIPAA standards while handling sensitive information.

Requirements

High school diploma required; Bachelor’s degree preferred.

4–6 years of relevant healthcare industry experience, including claims, reimbursement, provider contracts, payment integrity, or auditing.

Strong understanding of healthcare payment processes, claim adjustments, reimbursement policies, and regulatory requirements.

Experience analyzing large datasets, identifying trends, detecting anomalies, and developing evidence-based audit conclusions.

Proficiency with Microsoft Office applications, especially Excel, Word, Outlook, and Access.

Previous SQL experience strongly preferred, along with familiarity working with databases and reporting tools.

Strong analytical thinking, problem-solving abilities, attention to detail, and professional judgment.

Ability to manage multiple priorities independently while maintaining productivity and quality standards.

Excellent written and verbal communication skills with the ability to explain complex findings clearly.

Strong collaboration skills and ability to contribute effectively within a remote team environment.

Ability to maintain a secure home workspace with reliable high-speed internet connectivity.

Benefits

Competitive hourly compensation ranging from $29.00 to $34.25 per hour , depending on experience, education, skills, certifications, and business needs.

Eligibility for discretionary bonus consideration.

Remote work opportunity within the United States.

Medical, dental, and vision insurance coverage.

Disability and life insurance benefits.

401(k) savings plan.

Paid family leave and paid holidays.

Generous paid time off program ranging from 17–27 days annually, depending on level and tenure.

Opportunities for professional growth, training, and career development.

Opportunity to contribute to meaningful healthcare payment accuracy initiatives.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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