Cotiviti · 1 week ago
Senior Payment Accuracy Specialist (COB)
United States
Full-time
Remote
Senior Level
$36.50/hr - $38/hr
5+ years expCotiviti is a company that specializes in healthcare analytics, and they are seeking a Senior Payment Accuracy, Coordination of Benefits (COB) Specialist. The role involves mentoring team members, optimizing auditing processes, and ensuring compliance with healthcare regulations.
Responsibilities
This individual will work with a high degree of autonomy including independent thinking and responsibility for individual workflow and assignments
Acts as a mentor to all team members within the Business Unit
May assist with new hire onboarding and training of employees within the Business Unit
Collaborates when available with all levels of the business upon assigned projects and deliverables
Produces knowledge as a Subject Matter Expert (SME) in a multi-functional aspect for auditing as well as business optimization and innovation
Responsible for a portfolio-wide impact for the entirety of the business units and client partnerships
Develop and facilitates audit enhancements of new tools to aid in team members’ ability to perform their assigned responsibilities within the databases
Optimization to innovate new opportunities and discovery of the business, new concepts, recoveries, and the growth of the overall Business Unit
Multi–functional in strategizing, disseminating, and implementing cross-audit concepts
Performs quality control to thoroughly validate submissions prior to Client exportation of team members and own work outputs
Understands Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability
Has the ability to independently member select in Cotiviti tools, with a full understanding of client parameters
Demonstrates subject matter expert level of understanding of query and filter construction to identify opportunities
Demonstrates high level of organization and can pivot as needed per the business requirements
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 identifying errors and overpayments for our healthcare clients
Learn and use multiple computer software, systems, and technology
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
Qualification
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
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
Preferred
Bachelor's degree (Preferred) and/or a minimum of at least five (5) years of related experience in healthcare
At least 2 – 3 years Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Employees in current COB Specialist 2, Technical Specialist and/or Payment Accuracy Specialist 2 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
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.
5001-10000 employees
H1B Sponsorship
Cotiviti has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (165)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
Company data provided by crunchbase