Payment Accuracy COB Specialist

Role Description

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.

• Input accurate claim recovery information in the proprietary Cotiviti software tools.
• Assist with related inquiries throughout the claim recovery process.
• Work under direct supervision and be monitored for efficiency in production and quality review of assigned work.
• Demonstrate 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.
• Leverage Cotiviti audit tools such as the Recovery Management System (RMS), COB Tracker, and client-specific systems to conduct thorough member investigations.
• Create detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation.
• Meet or exceed standards of production and quality as identified by compliance and regulatory guidelines.
• Prepare and evaluate 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.
• Identify opportunities for continuous improvement for efficiencies within reporting and streamlining research processes.
• Demonstrate understanding of Cotiviti policies & procedures, and external regulatory requirements.
• Assure confidentiality and security of all data, adhering to all HIPAA laws and requirements.
• Take responsibility for outcomes and apply learning as applicable.
• Integrate information from various sources and consider broader context.
• Try unique ways of doing things and test promising ideas.
• Actively seek 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 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).
• Excellent verbal and written communication skills.
• An enthusiasm for working with large datasets and diverse databases.
• Thrive in both individual and team environments, showcasing self-motivation and determination to achieve success.
• Understand and embody Cotiviti's Core Values, Strategic Pillars, and Operations Disciplines.

Requirements

• Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies.
• Exceptional attention to detail to ensure accuracy in financial records and audit findings.
• Strong critical thinking skills, with the ability to assess complex situations.
• Make 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.

Benefits

• Base compensation ranges from $20.50 to $23.75 per hour.
• 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.
• Competitive benefits package including 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, depending on specific level and length of service.

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.