US-Remote
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.
- Has ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services.
- (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability.
- 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.
- 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.
- 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 in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
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.
Qualifications
- High School Diploma - Required
- At least 1-year Cotiviti experience is recommended for individuals seeking their next opportunity internally.
- (Example: Retrieval Agent and/or Audit Support positions).
- Healthcare industry experience, including knowledge of Coordination of Benefits. (Preferred).
- 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.
Mental 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. 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.
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.
- No adverse environmental conditions expected.
- 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.
Base compensation ranges from $20.00 to $23.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 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, or as otherwise required by applicable state law.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, 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, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Cotiviti values its diverse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)
