Senior Payment Accuracy Specialist (COB)

Cotiviti

2d•$37 - $38

About The Position

A Payment Accuracy, Coordination of Benefits (COB) Senior Specialist, 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. Individuals in the Senior Specialist role are passionate about what they do and are subject matter experts (SMEs) at identifying opportunities for strategic growth, reviewing, discovering, and validating substantial amounts of data, to deliver results and insights for our clients. The Payment Accuracy, Coordination of Benefits (COB) Senior Specialist is a subject matter expert (SME) which encompasses knowledge of all levels of auditing from low to complex situations. Additionally, this individual will hold many responsibilities including but not limited to acting as a mentor to other members of the team and developing and facilitating audit enhancements. Supports an expanding portfolio-wide impact to cross-audit concepts in strategy dissemination and implementation to identify optimizations.

Requirements

High School Diploma - Required
Bachelor’s degree (Preferred) and/or a minimum of at least five (5) years of related experience in healthcare.
At least 2 – 3 years Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Employees in current COB Specialist 2, Technical Specialist and/or Payment Accuracy Specialist 2 roles).
Healthcare industry experience, including knowledge of Coordination of Benefits. (Required).
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.
Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.
Communicating with others to exchange information.
Assessing the accuracy, neatness, and thoroughness of the work assigned.
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 (Preferred)

Responsibilities

This individual will work with a high degree of autonomy including independent thinking and responsibility for individual workflow and assignments.
Acts as a mentor to all team members within the Business Unit.
May assist with new hire onboarding and training of employees within the Business Unit.
Collaborates when available with all levels of the business upon assigned projects and deliverables.
Produces knowledge as a Subject Matter Expert (SME) in a multi-functional aspect for auditing as well as business optimization and innovation.
Responsible for a portfolio-wide impact for the entirety of the business units and client partnerships.
Develop and facilitates audit enhancements of new tools to aid in team members’ ability to perform their assigned responsibilities within the databases.
Optimization to innovate new opportunities and discovery of the business, new concepts, recoveries, and the growth of the overall Business Unit.
Multi–functional in strategizing, disseminating, and implementing cross-audit concepts.
Performs quality control to thoroughly validate submissions prior to Client exportation of team members and own work outputs.
Understands Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability.
Has the ability to independently member select in Cotiviti tools, with a full understanding of client parameters.
Demonstrates subject matter expert level of understanding of query and filter construction to identify opportunities.
Demonstrates high level of organization and can pivot as needed per the business requirements.
Utilizes Cotiviti audit tools (Recovery Management System (RMS), COB Tracker, specific client systems) to complete member investigations.
Creates detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation.
Meets or exceeds 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.
Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed.
Identify and solve problems by identifying errors and overpayments for our healthcare clients
Learn and use multiple computer software, systems, and technology.
Identifies opportunities for continuous improvement for efficiencies within reporting and streamline research processes.
Has an in depth understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
Has an advanced understanding of the healthcare industry, as well as proven track record of delivering results.
Assures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
Has ability to take responsibility for outcome, whether positive or negative and apply learning as applicable.
Integrates information from various sources and considers broader context
Creates innovation to enhance the standard operating rhythm finding new pathways to complete work expectations.
Actively seeks information to understand rationale and provide exceptional results beyond basic standards.

Benefits

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

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