Job Code: Pharmacy Candidates
Specialist - Payment Accuracy - Pharmacy graduates
Company Name: Cotiviti India Private Limited
- Work Experience Required: 01 Y to 07 Y
Minimum Education Requirements: Pharmacy graduates
Point of Contact for CV's / Email ID: Aparna.Umbarje@cotiviti.com
Cotiviti India Private Limited
There's a reason why so many of the largest healthcare payers and most successful retailers choose Cotiviti. It's because we deliver, year after year. The teams at Cotiviti Healthcare and Connolly, a division of Cotiviti, are renowned for relentlessly pursuing the best financial results for our clients. Ours is a unique approach that treats payment accuracy as a financial best practice encompassing the client's entire business. We apply analytics to identify patterns and incongruities, creating deep insights that
unlock value across the payment continuum.
Cotiviti offers an advanced technology platform built over decades of experience deciphering complex data, transactions and decisions in healthcare and retail. Cotiviti's world-class analytics combined with massive amounts of information - more than six petabytes of unique data - create an unmatched opportunity to generate insight that unlocks value for our clients.
Cotiviti employs professionals who are true experts in their field. Many have a background in the industries we serve. They're creative, innovative individuals who thrive on finding the answers to difficult questions. It's that diligence and attention to detail that enables us to exceed expectations in pursuit of client success.
For more information visit us @ www.cotiviti.com.
Cotiviti India Private Limited, Podium Floor, Binarius/Deepak Complex, Opp. Golf Course, Near Old WNS Office, Yerwada, Pune 411006
PRINCIPLE PURPOSE OF JOB
The Specialist, Payment Accuracy position is an entry level position responsible for auditing client data and generating high quality recoverable claims for the benefit of Connolly 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 so other reviewers may validate claim. Communicates audit recommendations to supervisory auditor for evaluation, verification and continuous learning.
Identifies and Enters Claims
o Under direct supervision, audits standard reports and identifies over and under payments of claims. Scope may include: quality assurance; auditing paid claims; determining whether an overpayment exists; duplicate payments; identifying incorrect contract or contract rates; Coordination of Benefits; Data Mining; Medical Chart Review; Medical Necessity; Claims Adjudication. Enters the claim into Cotiviti system accurately and in accordance with standard procedures. Can work on some simple/medium standard audit reports with support.
Effectively utilizes Audit Tools
o Utilizes with increasing proficiency, proprietary reports, tools and systems required to perform duties with moderate guidance and direction, timely executes assigned standard reports and updates. Working proficiency with all systems and applications including internal and client tools.
o Demonstrates adeptness in identifying errors and exceptions that result in valid claims. Has an eye for irregularities. Ability to analyze data, identify inconsistencies and formulate workable solutions. Makes logical, well-reasoned and timely decisions.
o Shows initiative and a willingness to engage in all areas of the audit. Reaches beyond current tasks to add value to audit team. Goes the extra step to solve problems instead of waiting for someone else to solve them. Successfully integrates and multi-tasks new assignments
o Demonstrates competency with tools of the job including but not limited to computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, and data file structures. Can efficiently download and format common file types.
o Treats customers/clients both internal and external as number one priority, is committed to continuous quality improvement, is courteous and responsive to customer's needs, meets or exceeds all customer commitments and treats customers honestly.
o Produces and documents well written claims, consistent with high level of integrity. Claims can be easily understood by client and provider/supplier community. Consistently meets or exceed goals at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.
o Ensures timely completion of audit reports. Exhibit's an understanding of audit planning activities and uses a structured and dependable approach to accomplishing assigned work.
o Identify opportunities to improve the efficiency of standard report to reduce false positives, streamline the research process and strive to increase the ID per hour. May offer suggestions and recommendations for process improvement and efficiencies.
Number of Vacancies: 20
No of rounds of Interviews: 4
Travel & Allowance: NO
Work Timings: 2pm to 11am
Any other skill set:
auditing, claims, data auditing, claims analysis
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