Payment Accuracy COB Specialist Job Locations

US-Remote ID

2024-13292

Category Audit - Healthcare  

Position Type Full-Time Overview

A Payment Accuracy, Coordination of Benefits (COB) 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. Our specialists are passionate about what they do and are experts at reviewing, discovering, and validating substantial amounts of data and delivering results and insights for our clients.

A Payment Accuracy, COB Specialist, is responsible for reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, this individual will be responsible for establishing the correct order of liability for our clients' members. This individual will also be responsible for inputting accurate claim recovery information in the proprietary Cotiviti software tools, as well as assisting with related inquiries throughout the claim recovery process.

Responsibilities

This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work. * Demonstrates a strong ability to proactively develop and uphold a solid grasp of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to accurately determine liability order. * Leverages cutting-edge Cotiviti audit tools such as the Recovery Management System (RMS), COB Tracker, and client-specific systems to conduct thorough 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 classifying errors and overpayments for our healthcare clients. * Identifies opportunities for continuous improvement for efficiencies within reporting and streamlining research processes. * Demonstrates understanding of Cotiviti policies and procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. * Has a basic 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 safe, 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. * Tries unique ways of doing things and tests promising ideas * Actively seeks information to understand rationale * Complete all responsibilities as outlined on annual Performance Plan. * Complete all special projects and other duties as assigned. * Must be able to perform duties with or without reasonable accommodation.

Qualifications

• High School Diploma - Required
• Bachelor's degree (Preferred) and/or a minimum of at least one (1) year related experience in healthcare.
• At least 1-year Cotiviti experience is recommended for individuals seeking their next oppor tunity internally.... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities