Payment Accuracy COB Specialist 2

This role is a subject-matter expert within the Coordination of Benefits (COB) Business Unit, focusing on situations where individuals are covered by multiple health plans. The specialist drives innovation, performs advanced data audits, quality checks, exports, appeals, and competitive intelligence to enhance outcomes for Cotiviti and its clients. This position handles moderate to complex audit projects with a high degree of autonomy.

Responsibilities

• Collaborate with all levels of the business on assigned projects and deliverables.
• Serve as a Subject Matter Expert (SME), sharing knowledge with junior specialists to build their experience.
• Introduce new ideas, research, and creative thinking to drive innovation.
• Distribute and manage inventory, filters, queries, and call assignments among team members.
• Work with multiple clients to produce impactful outcomes through advanced auditing, quality checks, exports, appeals, and competitive intelligence.
• Apply in-depth knowledge of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to determine the correct order of liability.
• Independently perform member selection in Cotiviti tools, adhering to client parameters.
• Construct advanced queries and filters to identify opportunities.
• Utilize Cotiviti audit tools (e.g., Recovery Management System, COB Tracker, client-specific systems) to complete member investigations.
• Document detailed, accurate notes in Cotiviti and client tools throughout member investigations.
• Meet or exceed production and quality standards set by compliance, regulatory guidelines, and leadership.
• Prepare and evaluate responses to client disputes both internally and externally.
• Identify errors and overpayments for healthcare clients, solving complex problems.
• Identify opportunities for continuous improvement in reporting and research processes.
• Apply advanced understanding of Cotiviti policies, procedures, and external regulatory requirements in daily duties.
• Maintain a strong grasp of the healthcare industry and deliver measurable results.
• Ensure confidentiality and security of all data, complying with HIPAA laws and requirements.
• Promote a safe work environment by adhering to industry standards.
• Take responsibility for outcomes, applying lessons learned from both positive and negative results.
• Integrate information from various sources to consider the broader context.
• Enhance standard operating procedures by finding innovative pathways to meet work expectations.
• Actively seek information to understand rationale and deliver results beyond basic standards.

Requirements

• High School Diploma (required).
• Bachelor’s degree (preferred) and/or 2–4 years of related experience in healthcare.
• 1–2 years of Cotiviti experience (recommended for internal candidates, e.g., current COB Specialist 1 or Payment Accuracy Specialist 2 roles).
• Healthcare industry experience, including knowledge of Coordination of Benefits (required).
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Excellent verbal and written communication skills.
• Strong interest in working with large datasets and various databases.
• Ability to work effectively both independently and as part of a team, demonstrating self-motivation.
• Alignment with Cotiviti’s Core Values, Strategic Pillars, and Operations Disciplines.

Skills

• 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 to assess complex situations and propose practical solutions.
• Methodical and strategic approach to challenges.
• Informed decision-making based on data, regulations, and auditing standards.
• Advanced understanding of auditing standards, regulations, and industry best practices.
• Ability to recognize and investigate inconsistencies or irregularities in financial records or processes.
• Effective collaboration within an audit team, contributing to a positive and productive dynamic.

Physical Requirements and Working Conditions

• Remaining in a stationary position (standing or sitting) for prolonged periods.
• Repeating motions involving wrists, hands, and/or fingers.
• Must provide a dedicated, secure work area with high-speed internet access and office setup.
• No adverse environmental conditions expected.

Pay

Base compensation ranges from $26.75 to $29.75 per hour. Specific offers are determined by factors such as experience, education, skills, certifications, and business needs. This role is eligible for discretionary bonus consideration. Nonexempt employees are eligible for overtime pay for hours worked in excess of 40 hours per week, or as required by applicable state law.

Benefits

• 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 level and length of service.