Payment Accuracy COB Specialist

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

📋 Description

• Analyze and review claims, as well as member and group data, to pinpoint recoverable claims for Cotiviti and its clients.

• Determine the appropriate order of liability for clients’ members.

• Accurately input claim recovery data into Cotiviti’s proprietary software systems.

• Provide assistance with inquiries during the claim recovery process.

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

• Utilize the Recovery Management System (RMS), COB Tracker, and client-specific systems for member investigations.

• Document precise and detailed notes in Cotiviti and/or client auditing tools.

• Achieve or surpass production and quality benchmarks while under direct supervision.

• Prepare and assess responses to client disputes.

• Categorize errors and overpayments for healthcare clients.

• Recognize opportunities for continuous improvement in reporting and research processes.

• Adhere to Cotiviti's policies, procedures, HIPAA regulations, and other compliance requirements.

• Ensure confidentiality and data security.

• Fulfill assigned performance-plan tasks, special projects, and additional responsibilities.

⛳️ Requirements

• A High School Diploma is mandatory.

• A Bachelor's degree is preferred.

• At least 1 year of relevant experience in the healthcare sector is required.

• Experience and understanding of the healthcare industry, specifically Coordination of Benefits, is preferred.

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

• Strong verbal and written communication abilities.

• Capability to work with extensive datasets and various databases.

• Skill in analyzing large amounts of data to detect trends, discrepancies, and anomalies.

• Outstanding attention to detail.

• Strong critical-thinking and problem-solving capabilities.

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

• Understanding of auditing standards, regulations, and best practices in the industry.

• Familiarity with CMS and NAIC guidelines.

• Knowledge of HIPAA laws and requirements.

• Capability to maintain a dedicated, secure workspace.

• Must have high-speed internet access/connectivity and be able to set up and maintain an office environment.

• Ability to perform tasks with or without reasonable accommodation.

🏝️ Benefits

• Consideration for discretionary bonuses.

• Coverage for medical insurance.

• Coverage for dental insurance.

• Coverage for vision insurance.

• Coverage for disability insurance.

• Coverage for life insurance.

• Participation in a 401(k) savings plan.

• Paid family leave.

• 9 paid holidays each year.

• 17–27 days of Paid Time Off (PTO) annually, based on position and tenure.

• Opportunity for remote work.

• Access to training and support for professional development.