Payment Accuracy COB Specialist 2

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

📋 Description

• Collaborate with various levels of the organization on designated projects and deliverables.

• Act as a subject matter expert, sharing insights with Specialists and Specialist 1 team members.

• Introduce innovative ideas, conduct research, and engage in creative problem-solving.

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

• Execute advanced audits for multiple clients.

• Carry out quality checks, exports, appeals, and competitive intelligence activities.

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

• Independently select members using client parameters within Cotiviti tools.

• Develop queries and filters to pinpoint opportunities.

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

• Generate precise and detailed investigation notes in Cotiviti and client audit tools.

• Achieve or surpass production and quality benchmarks for concept and claim identifications.

• Prepare and assess responses to client disputes.

• Detect errors and overpayments for healthcare clients.

• Identify continuous improvement opportunities in reporting and research methodologies.

• Perform responsibilities in alignment with Cotiviti policies, procedures, HIPAA regulations, and external guidelines.

• Analyze data from diverse sources while considering the broader context.

• Develop innovative strategies to enhance the standard operating rhythm and work processes.

⛳️ Requirements

• High School Diploma is required.

• Bachelor's degree is preferred.

• 2-4 years of relevant healthcare experience is necessary.

• Experience in the healthcare industry, including knowledge of Coordination of Benefits, is required.

• 1-2 years of experience with Cotiviti is recommended for internal candidates.

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

• Strong interest in working with large datasets and various databases.

• Capability to analyze large amounts of data and identify trends, discrepancies, and anomalies.

• Exceptional attention to detail in financial records and audit results.

• Strong critical thinking abilities to evaluate complex situations and propose effective solutions.

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

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

• Skill in investigating financial records to uncover issues, inconsistencies, and irregularities.

• Capacity to work effectively both independently and as part of an audit team.

• Ability to provide a dedicated, secure workspace.

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

• Compliance with HIPAA laws, industry standards, Cotiviti policies, and regulatory requirements is essential.

🏝️ Benefits

• Discretionary bonus eligibility.

• Overtime compensation for nonexempt employees for hours worked beyond 40 per week, or as mandated by applicable state law.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

• 17-27 days of Paid Time Off (PTO) per year, based on specific level and tenure.

• Remote work opportunities.

• Provision of a dedicated, secure workspace with high-speed internet and office setup support.