Payment Accuracy Specialist 1 – Coordination of Benefits

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $22 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Review and analyze multi-client impacts, complex member selections, and queries or filters to identify recoverable Coordination of Benefits claims • Establish the correct order of liability for client members • Input accurate claim recovery information into proprietary Cotiviti software tools • Assist with inquiries throughout the claim recovery process • Perform moderate to more complex audit projects ranging from low to midrange scope • Work under limited supervision while meeting production and quality standards • Run and establish queries and filters for data reports • Resolve data-related challenges • Apply CMS and NAIC guidelines to determine liability accurately • Use Cotiviti audit tools, including Recovery Management System (RMS), COB Tracker, and client systems, to conduct member investigations • Create accurate, detailed notes in Cotiviti and/or client audit tools • Review concept and claim identifications in accordance with compliance and regulatory guidelines • Prepare and evaluate responses to internal and external client disputes • Identify continuous-improvement opportunities in reporting and research processes • Maintain confidentiality and data security in accordance with HIPAA • Integrate information from multiple sources and develop improved ways to complete work

🎯 Requirements

• High School Diploma - Required • Bachelor’s degree preferred and/or a minimum of at least two (2) years related experience in healthcare • At least 1–2 years of Cotiviti experience 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 • Ability to work independently and in a team environment • Ability to analyze large volumes of data and identify trends, discrepancies, and anomalies • Exceptional attention to detail for accuracy in financial records and audit findings • Strong critical thinking and practical problem-solving skills • Ability to make informed decisions based on data, regulations, and auditing standards • Strong understanding of auditing standards, regulations, and industry best practices • Ability to investigate financial records or processes to uncover issues and irregularities • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and maintain an office setup • Must comply with 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 in excess of 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