Payment Accuracy COB Specialist 2

Role Description

A Payment Accuracy, Coordination of Benefits (COB) Specialist 2, 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. The Payment Accuracy, Coordination of Benefits (COB) Specialist 2 position is essentially a subject matter expert (SME), providing innovation to introduce new ideas, research as well as creative thinking. This individual will have the opportunity to demonstrate multi-client outcomes and impact. This individual will not only audit advanced data but will be responsible for quality checks, exports, appeals, comp intel, etc., to enhance both Cotiviti and the Clients. This position will have responsibility for moderate to more complex audit projects, executed with a high degree of autonomy for independent thinking and responsibility.

• 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.
• Has the ability to independently member select in Cotiviti tools, with a full understanding of client parameters.
• 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.
• Identifies and solves 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 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.

Qualifications

• 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.
• 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.

Requirements

• 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.
• Makes informed decisions based on available data, regulations, and auditing standards.
• Strong understanding of auditing standards, regulations, and industry best practices.
• Ability to recognize when something is wrong or needs further investigation.
• Ability to work effectively as part of an audit team, sharing insights, collaborating on tasks, and contributing to a positive and productive team dynamic.

Physical Requirements and Working Conditions

• 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.
• No adverse environmental conditions expected.

Benefits

• Base compensation ranges from $26.75 to $29.75 per hour.
• This role is eligible for discretionary bonus consideration.
• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week.
• Cotiviti offers a competitive benefits package 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.

Company Description

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.