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Cotiviti

Enabling a high-quality and viable healthcare system

Payment Accuracy Specialist 1

GeneralGeneralOtherRemoteMid LevelTeam 5,001-10,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

$23 - $26 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Payment Accuracy Specialist 1

Cotiviti

Role Description A Payment Accuracy, Coordination of Benefits (COB) Specialist 1 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. This role is responsible for reviewing and analyzing the multi-client impact, complex member selection, and query or filter construction of data to identify instances of recoverable Coordination of Benefit claims for the benefit of Cotiviti and our clients. - Works under limited supervision and is responsible for establishing the correct order of liability for our client’s members. - Inputs accurate claim recovery information in the proprietary Cotiviti software tools. - Assists with related inquiries throughout the claim recovery process. - Handles moderate to more complex audit projects, ranging from low to midrange in scope. Responsibilities - Monitored for efficiency in production and quality review of assigned work. - Demonstrates the ability to excel both independently and as a collaborative team player. - Involves complex member selections and multi-client impacts. - Runs and establishes queries and filters for construction and data reports. - Demonstrates proactive problem-solving skills and resolves data-related challenges efficiently. - Possesses in-depth knowledge of CMS and NAIC guidelines for determining liability accurately. - Utilizes Cotiviti audit tools (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. - Prepares and evaluates responses to client disputes both internally and externally. - Identifies opportunities for continuous improvement for efficiencies within reporting and streamlining research processes. - Demonstrates understanding of Cotiviti policies & procedures and external regulatory requirements. - Assures confidentiality and security of all data, adhering to HIPAA laws and requirements. - Takes responsibility for outcomes and applies learning as applicable. - Integrates information from various sources and considers broader context. - Creates innovation to enhance the standard operating rhythm. - Actively seeks information to understand rationale and provide exceptional results. Qualifications - High School Diploma - Required. - 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. - 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. 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 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 and collaborating on tasks. 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. Benefits - Base compensation ranges from $22.60 to $26.00 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.

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