Senior Payment Accuracy Specialist

Overview

A leading provider of payment accuracy services in the healthcare and retail industries is seeking a Senior Payment Accuracy Specialist to join their healthcare recovery team. This role focuses on improving healthcare payment integrity by developing and executing audit concepts, training audit staff, and ensuring high-quality recoverable claims for clients.

Responsibilities

• Develop new and existing audit concepts, including defining issues, developing criteria, and analyzing evidence for medium and complex audit reports.
• Lead concept development across multiple audit verticals, interact with clients to test and gain acceptance, and expand concepts based on customer requirements.
• Collaborate with Business Optimization and audit teams to develop new reports and implement technological improvements to enhance audit production and client satisfaction.
• Oversee quality control by reviewing auditor claims before and after client submission, ensuring audit quality and productivity goals are met.
• Prepare responses to client disputes by verifying claims validation and making determinations based on contract knowledge and recovery likelihood.
• Serve as a subject matter expert on provider contracts, medical policies, and state and federal statutes, implementing recommendations to fit projects within standard reports.
• Validate new claim types using audit tools to ensure concepts achieve desired recoveries and client acceptance.
• Participate in auditor development by training staff on audit projects and concepts, and assist in assessment, progression, and staffing functions.
• Perform quality control processes to ensure proper use of proprietary software, reports, and IT resources in audits.

Qualifications

• Bachelor's degree preferred.
• Minimum of three (3) years of direct audit experience with the organization or four (4) years of related experience in healthcare billing, medical claims, reimbursement, or analytics.
• Proficiency in SQL required.
• Strong computer skills, including Microsoft Excel, Access, and system databases.
• Ability to mentor and improve auditor performance in quality and productivity.
• Prior healthcare billing and claims experience is desired, with knowledge of industry standards.
• Excellent verbal and written communication skills.
• Ability to work effectively both independently and in a team environment.

Mental and Physical Requirements

• Effective communication skills for exchanging information.
• Ability to assess accuracy, neatness, and thoroughness of assigned work.
• Ability to remain stationary for prolonged periods, including standing or sitting.
• Capability to perform repetitive motions involving wrists, hands, and fingers.
• Must provide a dedicated, secure work area with high-speed internet access and maintain an appropriate office setup.
• No adverse environmental conditions expected.

Compensation and Benefits

• Base pay ranges from $37.75 to $40.25 per hour, with specific offers based on experience, education, skills, certifications, and business needs.
• Eligible for discretionary bonus consideration.
• Nonexempt employees qualify for overtime pay as applicable.
• Comprehensive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• Nine paid holidays per year.
• Paid Time Off ranging from 17 to 27 days annually, depending on level and length of service.

Location and Application Details

• Date of posting: 5/26/2026
• Applications are reviewed on a rolling basis.
• The application window is expected to close on 6/26/2026 but may close earlier depending on candidate selection or application volume.