Payment Accuracy Specialist 1 (Coordination of Benefits)

Responsibilities

• Work under limited supervision and monitor efficiency in production and quality review of assigned work.
• Demonstrate ability to excel independently and collaboratively, handle complex member selections and multi-client impacts.
• Run and establish queries and filters for construction and data reports, solve data-related challenges proactively.
• Utilize Cotiviti audit tools (Recovery Management System (RMS), COB Tracker, specific client systems) to complete member investigations.
• Create detailed, accurate notes in Cotiviti audit tools and/or client tools during member investigations.
• Maintain standards of production and quality as per compliance and regulatory guidelines.
• Prepare and evaluate responses to client disputes both internally and externally.
• Identify opportunities for continuous improvement in reporting and research processes.
• Understand and adhere to Cotiviti policies, procedures, and external regulatory requirements.
• Ensure confidentiality and security of all data, comply with HIPAA laws and requirements.
• Ensure a safe work environment, comply with industry standards.
• Show initiative in uncovering issues, inconsistencies, or irregularities in financial records or processes.
• Collaborate effectively as part of an audit team, share insights, and contribute to a positive team dynamic.

Qualifications

• High School Diploma - Required.
• Bachelor’s degree (Preferred) and/or minimum of 2 years related experience in healthcare.
• At least 1-2 years of Cotiviti experience recommended for internal candidates.
• 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, self-motivated to deliver success.