Payment Accuracy COB Specialist 2

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $26 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Collaborates when available with all levels of the business upon assigned projects and deliverables • Produces knowledge as a Subject Matter Expert (SME) providing knowledge share to Specialists and Specialist 1’s to gain experience within their assigned roles • Introduces new ideas, research, and creative thinking through an innovative scope • Operates with the distribution of inventory and isolation to designate and distribute filters, queries, and/or call assignments to team members • Working with multi–clients to produce impact and outcomes, this individual will have advanced auditing skills as well as the ability to perform quality checks, export, appeals, comp intel, etc • Has an in-depth understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability • Demonstrates advanced level of understanding of query and filter construction to identify opportunities • 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 • 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 the ability to take responsibility for outcomes, 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

🎯 Requirements

• High School Diploma Required • Bachelor’s degree (Preferred) and/or a minimum of at least 2-4 years related experience in healthcare • At least 1-2 years Cotiviti experience is recommended for individuals seeking their next opportunity internally • 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

🏖️ Benefits

• medical, dental, vision, disability, and 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