Payment Accuracy Specialist 1 – Coordination of Benefits

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

📋 Description

• Analyze and evaluate impacts from multiple clients, intricate member selections, and queries or filters to pinpoint recoverable Coordination of Benefits claims.

• Determine the appropriate order of liability for client members.

• Accurately enter claim recovery details into proprietary Cotiviti software tools.

• Provide assistance with inquiries during the claim recovery process.

• Conduct moderate to complex audit projects that range from low to midrange scope.

• Operate with limited supervision while adhering to production and quality standards.

• Execute and establish queries and filters for generating data reports.

• Address data-related issues effectively.

• Utilize CMS and NAIC guidelines to accurately ascertain liability.

• Employ Cotiviti audit tools, including Recovery Management System (RMS), COB Tracker, and client systems for member investigations.

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

• Review concepts and claim identifications in alignment with compliance and regulatory guidelines.

• Prepare and assess responses to both internal and external client disputes.

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

• Uphold confidentiality and data security as mandated by HIPAA.

• Synthesize information from various sources and devise enhanced methods to accomplish tasks.

⛳️ Requirements

• High School Diploma - Required.

• Bachelor’s degree preferred or a minimum of two (2) years of relevant experience in healthcare.

• Recommended 1–2 years of Cotiviti experience for those pursuing internal opportunities.

• Required experience in the healthcare industry, including knowledge of Coordination of Benefits.

• Proficient in computer applications, including Microsoft Office (Word, Excel, Outlook).

• Excellent verbal and written communication abilities.

• Strong passion for working with large datasets and diverse databases.

• Capability to work independently and collaboratively within a team setting.

• Skilled in analyzing extensive data volumes to identify trends, discrepancies, and anomalies.

• Exceptional attention to detail for accuracy in financial records and audit findings.

• Strong critical thinking and practical problem-solving capabilities.

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

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

• Competence in investigating financial records or processes to uncover issues and irregularities.

• Capacity to provide a dedicated and secure work area.

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

• Must adhere to HIPAA laws and requirements.

🏝️ Benefits

• Discretionary bonus consideration.

• 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 per year.

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

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

• Dedicated, secure work area and high-speed internet access/office setup supported as working conditions.