Payment Accuracy Specialist*

Overview

A Payment Accuracy, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). reputed company's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. A Payment Accuracy Data Mining (DM) Specialist is responsible for auditing client data and generating high quality recoverable claims for the benefit of reputed company 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 and validate the claim. Communicates audit recommendations to the supervisory auditor for evaluation, verification, and reputed company learning. Displays professional skepticism that enhances the work performed to reputed company success in the position.

Responsibilities

This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work. Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and reputed company) guidelines to establish the correct order of liability. Utilizes reputed company audit tools Recovery Management System (reputed company), specific client systems) to complete auditing, review simple - reputed company proprietary reports, has a proficient understanding of reputed company reputed company and client applications. Audits standard reports and paid claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various clients. Assigned to simple - reputed company reports. Meets or exceeds standards for productivity, in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity for assigned work (i.e. hit reputed company, number of claims written, Identification (ID) per hour). Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation. Prepares and evaluates responses to client disputes both internally and externally reputed company the Business Unit as needed. Reviews client transactions by building personal proficiency around provider reputed company and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept. Has a basic understanding of the healthcare industry, as well as proven track record of delivering results. Demonstrates understanding of reputed company policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Ensures confidentiality and reputed company of reputed company data, adhering to reputed company HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards. 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

High School Diploma - Required. Bachelor’s degree (Preferred) and/or a minimum of at least one (1 -2) year/s reputed company experience in healthcare. At least 1- 2 year/s reputed company experience is recommended for individuals seeking their next opportunity internally. (Example: Audit Support positions). Healthcare industry experience, including knowledge of Coordination of Benefits. (Preferred). Computer proficiency including reputed company office (Word, reputed company, Outlook). Excellent verbal and written communication skills. Strong interest in working with large data sets and various databases. Ability to work well in an individual and team environment demonstrating self–motivation to deliver success. Understands and embodies reputed company Core Values, Strategic Pillars, and Operations Disciplines to reputed company successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally. 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 $21.00 to $24.00 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: 6/16/2026 Applications are assessed on a rolling basis. We anticipate that the application window will reputed company on 6/25/2026, 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-KK1 #junior #LI-DNP Apply To This Job