Provider Services Analyst
Job Locations US-Remote
ID 2025-14097
Category
Audit - Healthcare
Position Type
Full-Time
Overview
A Provider Services Analyst (PSA) is a member of Credit Balance (CB) and our greater Coordination of Benefits (COB) and Data Mining (DM) teams who partner to identify and create a positive outcome for Cotiviti and the Clients we support as an enterprise. Credit Balance (CB) 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.
The role of a PSA is to conduct overpayment recoveries in the form of CB reviews. The PSA works under the supervision of the Manager. CB recoveries are obtained by reviewing patient accounting systems through analysis of created credits from incoming paid claims data, then identifying and resolving client overpayments made to healthcare providers for various reasons. PSAs are responsible for developing and managing provider relationships, conducting full recovery audits for all CB client and lines of business, and meeting monthly target production and Key performance indicators (KPIs) goals set by leadership.
Responsibilities
This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work. However, does display individual judgment within assigned work.
Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability.
Works within provider-patient accounting systems to analyze and resolve credit balances with a focus on discrepancies for overpayment recoveries for CB clients.
Creates detail-oriented, accurate notes in Cotiviti audit tools and/or client tools.
Meets or exceeds standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Manager when reviewing overpayments and claims data.
Utilize analytical data to resolve contractual equations for overpayment recoveries and debit/credit adjustments for account resolutions.
Demonstrates a proactive approach to ensuring requirements are met for accounts receivable (AR) and suspense.
Strong, accurate, and punctual communication skills with an emphasis on attention to detail.
Ability to multi-task daily while incorporating time management skills to achieve work balance.
Understand the expectations of monthly production and KPI targeted goals.
Effectively work as a remote employee meeting company work hours and scheduled meeting standards.
Manipulate provider system reporting using knowledge of coordination of benefit and third-party liability rules, contractual obligations, and billing codes to find overpayments for clients.
Ability to work independently to achieve expected work duties.
Ability to work and communicate well in a team environment as needed.
Qualifications
Bachelor’s degree (required), preferably in business, healthcare, accounting, or related field; or equivalent work experience.
1+ years’ experience in healthcare billing, audit or collection, or accounts receivable (preferred).
High proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
Experience with financial reporting analysis.
Demonstrated knowledge and understanding of the details of payer and patient remits.
Strong math skills in addition, subtraction, multiplication, division, fractions, and/or percentages with or without a calculator/Excel spreadsheet.
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.
Base compensation ranges from $22.00 to $26.20 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.
Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Cotiviti values its diverse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)
