Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on improving healthcare outcomes through data analysis, and they are seeking a Payment Accuracy, Coordination of Benefits Specialist. This role involves reviewing and analyzing claims and member data to identify recoverable claims, ensuring compliance with regulatory guidelines, and utilizing Cotiviti's proprietary tools for effective claim recovery.
Responsibilities
- This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work
- Demonstrates 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
- Leverages cutting-edge Cotiviti audit tools such as the Recovery Management System (RMS), COB Tracker, and client-specific systems to conduct thorough 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 on annual Performance Plan
- Complete all special projects and other duties as assigned
- Must be able to perform duties with or without reasonable accommodation
Skills
- High School Diploma - Required
- Computer proficiency including Microsoft office (Word, Excel, Outlook)
- Excellent verbal and written communication skills
- An enthusiasm for working with large datasets and diverse databases will set you up for success in this position
- You thrive in both individual and team environments, showcasing self-motivation and determination to achieve success
- Understands and embodies Cotiviti's Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the organization, both internally and externally
- 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
- 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. (Example: Retrieval Agent and/or Audit Support positions)
- Healthcare industry experience, including knowledge of Coordination of Benefits (Preferred)
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 Overview
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. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is http://www.cotiviti.com.
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