Payment Integrity Specialist

Cotiviti

Payment Integrity Specialist auditing healthcare claims for private health insurers. Providing insights into billing practices and supporting business development activities for the company.

Posted 6/25/2026full-timeRemote • 🇦🇺 AustraliaMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Audit healthcare claims on behalf of our private health insurance clients to detect and recover overpayment.
Review clinical documentations submitted by providers.
Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover overpayments.
Support the growth of the Payment Integrity Practice by supporting business development activities.
Strictly respect the confidentiality of all sensitive company and client information.

Requirements

What you’ll need

One of the following qualifications: Bachelor’s Degree (Nursing or equivalent) with experience in Critical care, emergency department or operating theatre experience preferred.
Health Information Manager.
Clinical coder with a coding qualification with 5-8 years' experience.
Experience in auditing private hospital claims.
Clinical coding experience highly desired.
Understanding of private health insurance legislation and private hospital funding models.
Experience working in the private health insurance sector or in private hospital audit.
Familiarity with 3M codefinder.
Excellent written and verbal communication skills.
Effective time management, planning and organizational skills.
Maintain knowledge and expertise by attending appropriate educational sessions.
Ability to work remotely from home office.

Benefits

Comp & perks

Health Information Manager
Clinical coder with a coding qualification with 5-8 years' experience.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical codingauditinghealthcare claims auditingcoding qualificationcritical care experienceemergency department experienceoperating theatre experienceprivate health insurance legislationprivate hospital funding models3M codefinder

Soft Skills

written communicationverbal communicationtime managementplanning skillsorganizational skills

Certifications

Bachelor’s Degree in NursingHealth Information Manager