Payment Accuracy Specialist 1 (Coordination of Benefits)

Cotiviti•Remote,

3d•$23 - $26•Remote

About The Position

A Payment Accuracy, Coordination of Benefits (COB) Specialist 1 is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans. This role is responsible for reviewing and analyzing the multi-client impact, complex member selection, and query or filter construction of data to identify instances of recoverable Coordination of Benefit claims for the benefit of Cotiviti and our clients. This individual works under limited supervision and is responsible for establishing the correct order of liability for our client’s members. Additionally, they input accurate claim recovery information in the proprietary Cotiviti software tools and assist with related inquiries throughout the claim recovery process. The position involves responsibility for moderate to more complex audit projects, ranging from low to midrange in scope.

Requirements

High School Diploma
Minimum of at least two (2) years related experience in healthcare.
Healthcare industry experience, including knowledge of Coordination of Benefits
Computer proficiency including Microsoft Office (Word, Excel, Outlook).
Excellent verbal and written communication skills.
Strong interest in working with large data sets and various databases.
Ability to work well in an individual and team environment demonstrating self–motivation to deliver success.
Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies.
Exceptional attention to detail to ensure accuracy in financial records and audit findings.
Strong critical thinking skills, with the ability to assess complex situations, identify key issues, and propose practical solutions.
Ability to approach challenges methodically and with a strategic mindset.
Ability to make informed decisions based on available data, regulations, and auditing standards.
Ability to weigh options and make recommendations that align with both compliance requirements and organizational goals.
Strong understanding of auditing standards, regulations, and industry best practices.
Ability to apply these standards consistently to ensure accurate and compliant audit processes.
Ability to recognize when something is wrong or needs further investigation.
Initiative to probe deeper into financial records or processes to uncover issues, inconsistencies, or irregularities.
Ability to work effectively as part of an audit team, sharing insights, collaborating on tasks, and contributing to a positive and productive team dynamic.
Remaining in a stationary position, often standing or sitting for prolonged periods.
Repeating motions that may include the wrists, hands, and/or fingers.
Must be able to provide a dedicated, secure work area.
Must be able to provide high-speed internet access / connectivity and office setup and maintenance.

Nice To Haves

Bachelor’s degree
At least 1-2 years of Cotiviti experience is recommended for individuals seeking their next opportunity internally (e.g., employees in current COB Specialist or Payment Accuracy Specialist roles).

Responsibilities

Work under limited supervision and be monitored for efficiency in production and quality review of assigned work.
Demonstrate the ability to excel both independently and as a collaborative team player.
Handle complex member selections and multi-client impacts.
Run and establish queries and filters for construction and data reports.
Demonstrate proactive problem-solving skills and a keen ability to resolve data-related challenges efficiently, contributing to a solution-driven environment.
Possess an in-depth knowledge of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines, crucial for determining liability accurately.
Utilize Cotiviti audit tools (Recovery Management System (RMS), COB Tracker, specific client systems) to complete member investigations.
Create detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation.
Meet or exceed standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Team Lead and/or Manager when reviewing concept and claim identifications for the client.
Prepare and evaluate responses to client disputes both internally and externally within the Business Unit as needed.
Identify opportunities for continuous improvement for efficiencies within reporting and streamlining research processes.
Demonstrate understanding of Cotiviti policies & procedures, and external regulatory requirements and perform duties in accordance with such regulatory requirements.
Demonstrate a deep understanding of the healthcare industry and a track record of delivering exceptional results.
Assure confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrate the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
Take responsibility for outcome, whether positive or negative and apply learning as applicable.
Integrate information from various sources and consider broader context.
Create innovation to enhance the standard operating rhythm finding new pathways to complete work expectations.
Actively seek information to understand rationale and provide exceptional results beyond basic standards.

Benefits

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance
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 with Cotiviti
Discretionary bonus consideration
Overtime pay for hours worked in excess of 40 hours in a given week