Provider Services Analyst

Overview

A Provider Services Analyst (PSA) is a member of Credit Balance (CB) and our greater Coordination of Benefits (COB) and Data Mining (DM) teams who partner to identify and create a positive outcome for Cotiviti and the Clients we support as an enterprise. Credit Balance (CB) consists of overpayment recovery specialists who work with both clients and providers to identify and reconcile overpayments at the provider level. CB offers a comprehensive and integrated approach to post-payment adjudication by leveraging payer and provider relationships to resolve credits effectively and accurately.

The role of a PSA is to conduct overpayment recoveries in the form of CB reviews. The PSA works under the supervision of the Manager. CB recoveries are obtained by reviewing patient accounting systems through analysis of created credits from incoming paid claims data, then identifying and resolving client overpayments made to healthcare providers for various reasons. PSAs are responsible for developing and managing provider relationships, conducting full recovery audits for all CB client and lines of business, and meeting monthly target production and Key performance indicators (KPIs) goals set by leadership.

Responsibilities

• This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work. However, does display individual judgment within assigned work.
• Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability.
• Works within provider-patient accounting systems to analyze and resolve credit balances with a focus on discrepancies for overpayment recoveries for CB clients.
• Creates detail-oriented, accurate notes in Cotiviti audit tools and/or client tools.
• Meets or exceeds standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Manager when reviewing overpayments and claims data.
• Utilize analytical data to resolve contractual equations for overpayment recoveries and debit/credit adjustments for account resolutions.
• Demonstrates a proactive approach to ensuring requirements are met for accounts receivable (AR) and suspense.
• Strong, accurate, and punctual communication skills with an emphasis on attention to detail.
• Ability to multi-task daily while incorporating time management skills to achieve work balance.
• Understand the expectations of monthly production and KPI targeted goals.
• Effectively work as a remote employee meeting company work hours and scheduled meeting standards.
• Manipulate provider system reporting using knowledge of coordination of benefit and third-party liability rules, contractual obligations, and billing codes to find overpayments for clients.
• Ability to work independently to achieve expected work duties.
• Ability to work and communicate well in a team environment as needed.

Qualifications

• Bachelor’s degree (required), preferably in business, healthcare, accounting, or related field; or equivalent work experience.
• 1+ years’ experience in healthcare billing, audit or collection, or accounts receivable (preferred).
• High proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• Experience with financial reporting analysis.
• Demonstrated knowledge and understanding of the details of payer and patient remits.
• Strong math skills in addition, subtraction, multiplication, division, fractions, and/or percentages with or without a calculator/Excel spreadsheet.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $22.00 to $26.20 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 1/17/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 1/31/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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