Senior Payment Accuracy Specialist

Job Summary

A company is looking for a Senior Payment Accuracy Specialist in Pharmacy Data Mining.

Key Responsibilities:

• Develop new audit concepts and tools, review claims, and prepare responses to client disputes
• Validate new claim types, review provider contracts, and train audit team members
• Perform quality control, assess claim association, and ensure proper execution of audit work

Required Qualifications:

• Bachelor's degree preferred with 3 years of Cotiviti direct audit experience or 4 years related experience in pharmaceutical billing or PBM audit processes
• Experience in pharmacy billing, knowledge of Datameer and SQL, and proficiency in Microsoft Excel and Access
• Working knowledge of healthcare billing standards, including billing practices concerning Drugs and Biologicals
• Prior experience in healthcare billing or claims is desired
• Ability to mentor staff and enhance their performance in quality and productivity