A Client Account Specialist is a member of our greater Data Mining (DM) and Coordination of Benefits (COB) Business Unit (BU) teams who partner to identify and create a positive outcome for Cotiviti and the Clients we support as an enterprise. This role resides in the Credit Balance (CB) team which 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.

As a Client Account Specialist this role is responsible for providing post-pay cost containment solutions for our clients. This role supports CB analysts by conducting due diligence to ensure refunds can be pursued, received, and verify provider payments as well as submitting deliverables to our clients and invoice upon completion of our reviews. 

• This individual will work under direct supervision and will be monitored for efficiency of assigned work.
• Manages insurance claims, invoices, and payments to ensure properly coded for services, procedures, diagnoses, and treatments received based on contracting.
• Creates and delivers client specific submission files to initiate invoicing.
• Provides support/direction for Pre-Identification process.
• Responsible for communication with internal and external clients.
• Applies developed subject matter knowledge to address and resolve common and complex issues within established guidelines.
• Research issues and disparities such as double dips and incorrect refunds. 
• Mediates between clients and providers.
• Generates financial and billing reports according to company guidelines.
• Keep updated records of financial transactions and customer account status.
• Review billing reports to ensure accuracy and resolve any errors.
• Evaluates, interprets, and analyzes client exceptions, contract discrepancies, and resolves void trends.
• Documents and maintains updated policies and procedures for client specific processes.
• Identifies refund trends that can be applied across contract base to maximize revenue and makes recommendations for efficiencies.
• Monitors void rate for assigned clients and identifies trends and potential process improvements.
• Participates in internal and client meetings to provide project updates and report on specific provider related successes and identify areas of improvement.
• Manages aging inventory.
• Exceeds established production and revenue goals set forth by management.
• Acts as a Cotiviti ambassador to create and maintain relationships on behalf of Cotiviti internally and externally.
• Ability to work independently to achieve expected work duties.
• Ability to work and communicate well in a team environment as needed.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Has a basic understanding of the healthcare industry, as well as proven track record of delivering results.
• Assures confidentiality and security of all data, adhering to all 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.
• Develops reasonable and effective recommendations and solutions that reflect an understanding of the client environment and risks inherent to our business and industry.
• Suggests and/or develops and implements new ideas, approaches and/or technological improvements that will support and enhance production, communication, and client satisfaction.
• Completes detailed rebuttal process for all client/provider denials
• Conducts monthly/quarterly void analysis. Monitors void rate for all clients and identifies trends and potential process improvements.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

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 Cotiviti and the requirements of the job change.

• High School Diploma or GED (required).
• Bachelor’s or Associates’ degree (preferred).
• At least 3 years experience in healthcare billing (required).
• At least 2 years of Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Provider Services Analyst). 
• Excellent written and verbal communication skills, with the ability to multitask and prioritize projects to meet scheduled deadlines.
• Proficient in Microsoft Office Suite, including PowerPoint, Word, Excel, and Outlook.
• Ability to work well in an individual and team environment demonstrating self–motivation to deliver success both in a remote and on-site location.

Mental Requirements:

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

Physical Requirements and Working Conditions:

• Very minimal travel for onsite meetings (approx. 5%) as directed by leadership.
• 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 are expected.

Base compensation ranges from $26.40 to $34.70 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: 1/10/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 1/24/2025, 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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