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.

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

• Enter precise claim recovery details into Cotiviti software tools.

• Provide assistance with inquiries throughout the claim recovery process.

• Operate under direct supervision while meeting production and quality benchmarks.

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

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

• Document accurate notes in Cotiviti and/or client audit tools.

• Assess concept and claim identifications for clients in alignment with compliance and regulatory standards.

• Prepare and review responses to disputes from internal and external clients.

• Categorize errors and overpayments for healthcare clients.

• Recognize opportunities to enhance reporting efficiency and simplify research processes.

• Adhere to Cotiviti policies, procedures, HIPAA regulations, and external laws.

• Fulfill annual Performance Plan responsibilities, special projects, and other assigned tasks.

⛳️ Requirements

• High School Diploma - Required.

• Bachelor’s degree (Preferred) and/or at least one (1) year of relevant experience in healthcare.

• A minimum of 1-year experience with Cotiviti is advisable for individuals pursuing internal opportunities.

• Experience in the healthcare industry, including familiarity with Coordination of Benefits (Preferred).

• Proficiency in computers, including Microsoft Office (Word, Excel, Outlook).

• Exceptional verbal and written communication abilities.

• Capability to work with large datasets and various databases.

• Ability to maintain a dedicated and secure workspace.

• Access to high-speed internet connectivity and office setup and maintenance.

• Skill in analyzing large volumes of data to uncover trends, discrepancies, and anomalies.

• Strong critical thinking and practical problem-solving skills.

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

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

• Ability to identify issues that warrant further investigation.

• Must be capable of performing duties with or without reasonable accommodation.

🏝️ Benefits

• Consideration for discretionary bonuses.

• Eligibility for overtime pay for hours worked beyond 40 hours per week, or as mandated by applicable state law.

• Coverage for medical, dental, vision, disability, and life insurance.

• 401(k) savings plan options.

• Paid family leave.

• 9 paid holidays each year.

• 17–27 days of Paid Time Off (PTO) annually, depending on level and length of service.