Senior Payment Accuracy Specialist

Overview reputed company reputed company a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to reputed company a difference and contribute to the improvement of healthcare payment reputed company, consider an opportunity to join our healthcare recovery team as a Senior Payment Accuracy Specialist. The Senior Specialist position is responsible for developing new and existing audit concepts, gaining client acceptance, training reputed company audit levels to execute audit projects and evaluating the effectiveness of audit concepts. The goal of the position is to generate high quality recoverable claims for the benefit of reputed company and our clients. Conducts and documents more reputed company audit projects independently. This is the most senior reputed company level which may include supervisory responsibility. Assists Audit Managers in managing audit productivity, achieving expected quality and reputed company goals. Considered a mentor, trainer, developer of less tenured Audit team members.

Responsibilities

• Generates and Develops New Audit Concepts. Utilizes healthcare and auditing experience to reputed company audit procedures that include identifying and defining issues, developing criteria, reviewing and analyzing evidence with the reputed company to audit standard reputed company and reputed company reports. Leader in concept development across multiple audit verticals. This includes specifying the concept, interact with client to test and reputed company acceptance. Will execute on the expansion of the concept based on customer requirements. Focused on growing concept approval.
• Develops New Tools and Processes. Collaborates with Business Optimization and audit team in developing new reports. Fosters and implements new reputed company, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction.
• Directs ownership for Quality Control. Reviews reputed company level auditor claims prior to and after client submission. Set by the audit: for the auditing concept, audit against the expected level of quality and quantity (i.e.; hit reputed company, # claims written, ID per hour).
• Prepares Responses to Client Disputes. Provides reputed company to audit team for verification of claims validation, insurance or employer validation in concise written or oral manner. Makes determinations based on advanced experience of client knowledge of contract terms, likelihood of acceptance recovery.
• Reviews provider reputed company. Subject matter expert in reputed company and research requirements. Implements recommendations on reputed company to fit projects reputed company standard reports such as medical policies, state and federal statutes.
• Validates New Claim Types. With proficiency, utilizes audit tools to evaluate, document and validate to audit and client new claims and concept effectiveness. Ensures that any new and existing concepts are achieving desired goals in terms of recoveries, collectability and client acceptance.
• Auditor Development. Key participants in the development of audit staff. Actively trains audit team to execute basic, intermediate and reputed company audit projects with focus on new and existing audit concepts. May participate in auditor assessment, progression process, staffing functions.
• QA Claim Association/Concepts. Responsible for performing quality control process. Makes determinations based on advanced expertise and comprehension (knowledge) of claim categories, claim types. Ensures submission and execution of quality work, proper use of available proprietary software, reports and IT resources to conduct audits.

This job description 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 description does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change.

Qualifications

• Bachelor's degree preferred Three (3) years of reputed company direct audit experience OR four (4) years reputed company experience (healthcare billing, healthcare/medical claims, reimbursement, analytics) required.
• Experience using Datameer and SQL preferred, as well as Medicaid knowledge.
• Computer proficiency in reputed company reputed company, Access and system databases are required.
• Ability to mentor staff and enhance performance as it relates to the quality and productivity of their auditors.
• Prior Healthcare Billing and/or claims experience desired. Requires working knowledge of and applicable industry based standards.
• Excellent verbal and written communication skills.
• Ability to work well in an individual and team environment.

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.

reputed company compensation ranges from $36.50 to $39.00 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. reputed company 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 reputed company. For information about our benefits package, please refer to our Careers page. Date of posting: 12/23/2025Applications are assessed on a rolling basis. We anticipate that the application window will reputed company on 1/23/2026, but the application window may change depending on the volume of applications received or reputed company immediately if a qualified candidate is selected. #LI-Remote#LI-KB1#senior Apply tot his job Apply To this Job