Payment Accuracy COB Specialist at Cotiviti in Remote

Summary: Cotiviti is a company focused on healthcare audit and data analysis, and they are seeking a Payment Accuracy, Coordination of Benefits Specialist. The role involves reviewing and analyzing claims data to identify recoverable claims and ensuring compliance with industry guidelines. Responsibilities: - Reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti and our clients - Establishing the correct order of liability for our clients’ members - Inputting accurate claim recovery information in the proprietary Cotiviti software tools - Assisting with related inquiries throughout the claim recovery process - Demonstrating 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 - Leveraging Cotiviti audit tools such as the Recovery Management System (RMS), COB Tracker, and client-specific systems to conduct thorough member investigations - Creating detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation - Meeting or exceeding standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Team Lead and/or Manager - Preparing and evaluating responses to client disputes both internally and externally within the Business Unit as needed - Identifying and solving problems by classifying errors and overpayments for our healthcare clients - Identifying opportunities for continuous improvement for efficiencies within reporting and streamlining research processes - Demonstrating understanding of Cotiviti policies & procedures, and external regulatory requirements and performing duties in accordance with such regulatory requirements - Assuring confidentiality and security of all data, adhering to all HIPAA laws and requirements - Taking responsibility for outcome, whether positive or negative and applying learning as applicable - Integrating information from various sources and considering broader context - Trying unique ways of doing things and testing promising ideas - Actively seeking information to understand rationale - Completing all responsibilities as outlined on annual Performance Plan - Completing all special projects and other duties as assigned Required Qualifications: - High School Diploma - Required - Excellent verbal and written communication skills - An enthusiasm for working with large datasets and diverse databases will set you up for success in this position - You thrive in both individual and team environments, showcasing self-motivation and determination to achieve success - 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 & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements - 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 - Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies - Must have exceptional attention to detail to ensure accuracy in financial records and audit findings - Demonstrates strong critical thinking skills, with the ability to assess complex situations, identify key issues, and propose practical solutions - Able to approach challenges methodically and with a strategic mindset - Makes informed decisions based on available data, regulations, and auditing standards - Must be able 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 - Must be able to apply these standards consistently to ensure accurate and compliant audit processes - Ability to recognize when something is wrong or needs further investigation - Must have the initiative to probe deeper into financial records or processes to uncover issues, inconsistencies, or irregularities - 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 Preferred Qualifications: - Bachelor's degree (Preferred) and/or a minimum of one (1) year of related experience in healthcare - At least 1-year Cotiviti experience is recommended for individuals seeking their next opportunity internally - Healthcare industry experience, including knowledge of Coordination of Benefits (Preferred) - Computer proficiency including Microsoft office (Word, Excel, Outlook) - Strong understanding of auditing standards, regulations, and industry best practices Required Skills: Coordination of Benefits, Healthcare industry knowledge, Claims analysis, Data analysis, Microsoft Office, CMS guidelines, NAIC guidelines, Audit standards, HIPAA compliance, Audit tools - Recovery Management System (RMS), Audit tools - COB Tracker, Client-specific audit systems Benefits: Medical, Dental, Vision, Disability, 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 with Cotiviti.