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Cotiviti · 1 day ago

Payment Accuracy Specialist 1 (Coordination of Benefits)

United States

Full-time

Remote

Entry Level

$22.60/hr - $26/hr

2+ years exp

Cotiviti is a company focused on healthcare solutions, and they are seeking a Payment Accuracy, Coordination of Benefits Specialist 1. This role involves reviewing and analyzing claims to identify recoverable Coordination of Benefit claims and requires establishing the correct order of liability for clients' members.

Information Technology & Services

Responsibilities

This individual will work under limited supervision and will be monitored for efficiency in production and quality review of assigned work

Demonstrates the ability to excel both independently and as a collaborative team player

The scope of work involves complex member selections and multi-client impacts

Capability and comfort in running and establishing queries and filters for construction and data reports

Demonstrates proactive problem-solving skills and a keen ability to resolve data-related challenges efficiently, contributing to a solution-driven environment

Possesses an in-depth knowledge of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines, crucial for determining liability accurately

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 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

Demonstrates a deep understanding of the healthcare industry and a track record of delivering exceptional 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

Qualification

Healthcare industry experienceCoordination of Benefits knowledgeData analysis skillsCotiviti software proficiencyMicrosoft Office proficiencyVerbal communication skillsWritten communication skillsTeam collaborationProblem-solving skills

Required

High School Diploma - Required

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

Preferred

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 is recommended for individuals seeking their next opportunity internally (e.g., employees in current COB Specialist or Payment Accuracy Specialist roles)

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.

Company

Cotiviti

Glassdoor3.7

Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.

Founded in 1979

South Jordan, UT, US

5001-10000 employees