Shire Jobs

Payment Accuracy COB Specialist 1 Job Locations

US-Remote ID

2024-13358

Category Audit - Healthcare  

Position Type Full-Time Overview

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. The Payment Accuracy, Coordination of Benefits (COB) Specialist 1 position 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. Under limited supervision, this individual will be responsible for establishing the correct order of liability for our client's members. In addition to establishing primacy, this individual will also be responsible for inputting accurate claim recovery information in the proprietary Cotiviti software tools, as well as assisting with related inquiries throughout the claim recovery process. The position will have responsibility for moderate to more complex audit projects, low to midrange in scope.

Responsibilities

This individual will work under limited supervision and will be monitored for efficiency in production and quality review of assigned work. * Ability to work independently and as a collaborator when the opportunities present themselves. * The scope of work will entail complex member selections and multi-client impacts. * Capability and comfort in running and establishing queries and filters for construction and data reports. * Moderate identification for problem-solving and resolution in data. Ability to process rationale in a solution based environment proactively. * Has a thorough understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability. * 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. * Identifies opportunities for continuous improvement for efficiencies within reporting and streamlining research processes. * Demonstrates understanding of Cotiviti policies and procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. * Has a thorough 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.

Qualifications

*  High... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities