Accountabilities:
The Senior Payment Accuracy Specialist is responsible for leading complex audit activities, improving payment accuracy outcomes, and supporting business optimization initiatives. The role requires strong analytical capabilities, healthcare expertise, and the ability to act as a trusted advisor across teams.
Conduct advanced Coordination of Benefits (COB) audits to identify payment accuracy opportunities, recoveries, and potential overpayments for healthcare clients.
Serve as a subject matter expert on audit processes, healthcare regulations, and optimization strategies across the business unit.
Independently manage assigned workflows, investigations, and projects while prioritizing changing business needs.
Analyze large datasets, develop insights, and identify trends that support strategic decision-making and operational improvements.
Utilize audit platforms, databases, and client systems to perform member investigations and document findings accurately.
Apply knowledge of CMS and NAIC guidelines to determine appropriate order of liability and ensure compliance.
Perform quality control reviews to validate audit submissions and ensure accuracy before client delivery.
Develop and facilitate audit enhancements, process improvements, and innovative solutions that improve team efficiency.
Mentor team members, support onboarding activities, and share best practices to strengthen overall team capabilities.
Collaborate with internal stakeholders and client partners on projects, disputes, reporting, and business initiatives.
Maintain detailed documentation while ensuring compliance with HIPAA requirements, confidentiality standards, and company policies.
Identify opportunities to streamline research processes, improve reporting capabilities, and enhance operational performance.
Requirements:
The ideal candidate brings healthcare payment accuracy experience, strong analytical skills, and the ability to operate independently while contributing to team success. This role requires attention to detail, excellent communication, and a continuous improvement mindset.
High school diploma required; bachelor’s degree preferred.
Minimum of five years of related healthcare industry experience, including knowledge of Coordination of Benefits processes.
Experience with healthcare auditing, payment accuracy, claims review, or recovery operations.
Strong understanding of healthcare regulations, including CMS and NAIC guidelines.
Experience working with large datasets, databases, and analytical tools.
Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
Experience using audit platforms and healthcare technology systems is preferred.
Strong written and verbal communication skills with the ability to explain complex information clearly.
Ability to work independently, manage multiple priorities, and deliver results in a fast-paced environment.
Strong problem-solving skills with the ability to identify opportunities and recommend improvements.
Detail-oriented approach with strong organizational skills and commitment to quality.
Ability to maintain confidentiality and follow HIPAA and data security requirements.
Must have a dedicated, secure remote workspace with reliable high-speed internet connectivity.
Benefits:
Competitive hourly compensation ranging from $37.75 to $39.50 per hour , with final offers based on experience, education, skills, certifications, and business needs.
Eligibility for discretionary bonus consideration.
Medical, dental, vision, disability, and life insurance coverage.
401(k) savings plan.
Paid family leave benefits.
Paid holidays and generous paid time off program.
Flexible remote work opportunity.
Opportunities for professional development, learning, and career growth.
Supportive team environment focused on collaboration, innovation, and continuous improvement.
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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