Payment Accuracy COB Specialist 2

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with all levels across the organization on assigned projects and deliverables.

• Act as a subject matter expert and share expertise with Specialists and Specialist 1s.

• Present new concepts, conduct research, and engage in creative thinking.

• Allocate inventory and assign filters, queries, and/or call tasks to team members.

• Execute advanced audits for multiple clients.

• Conduct quality assessments, exports, appeals, and competitive intelligence activities.

• Apply CMS and NAIC guidelines to determine the appropriate order of liability.

• Independently select members in Cotiviti tools based on client parameters.

• Develop queries and filters to pinpoint opportunities.

• Utilize RMS, COB Tracker, and client systems to carry out member investigations.

• Generate precise, detailed notes in audit and client tools.

• Achieve or surpass production and quality targets while reviewing concepts and claim identifications.

• Prepare and assess responses to client disputes.

• Detect errors and overpayments for healthcare clients.

• Recognize continuous-improvement opportunities in reporting and research methodologies.

• Execute responsibilities in alignment with Cotiviti policies, procedures, and regulatory standards.

• Safeguard confidentiality and security of data in compliance with HIPAA.

• Foster innovative approaches to enhance standard operating processes.

• Synthesize information from various sources and produce results that exceed basic expectations.

⛳️ Requirements

• High School Diploma is mandatory.

• Bachelor’s degree is preferred.

• A minimum of 2-4 years of relevant experience in the healthcare sector.

• Experience in the healthcare industry with a strong understanding of Coordination of Benefits is required.

• 1-2 years of experience at Cotiviti is recommended for internal candidates pursuing their next opportunity.

• Proficiency in computer applications, including Microsoft Office, Word, Excel, and Outlook.

• A strong interest in working with large data sets and various databases.

• Capability to analyze extensive volumes of data and identify trends, discrepancies, and anomalies.

• Exceptional attention to detail regarding financial records and audit findings.

• Strong critical-thinking and problem-solving abilities.

• Ability to make informed decisions based on data, regulations, and auditing standards.

• Comprehensive understanding of auditing standards, regulations, and industry best practices.

• Capacity to investigate financial records and identify issues, inconsistencies, or irregularities.

• Proficient in working independently and as part of an audit team.

• Ability to maintain confidentiality and adhere to HIPAA regulations.

• Capability to provide a secure and dedicated workspace.

• Ability to ensure access to high-speed internet and maintain an office setup.

• Capacity to remain stationary, often standing or sitting for extended periods.

• Ability to perform repetitive motions involving the wrists, hands, and/or fingers.

🏝️ Benefits

• Discretionary bonus consideration.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, based on specific level and length of service with Cotiviti.

• Remote work arrangement.

• Equal employment opportunity.