Payment Accuracy Specialist 1

Job Description

REQUIREMENTS

• 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 (e.g., employees in current COB Specialist or Payment Accuracy Specialist roles).
• 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.

RESPONSIBILITES

• Utilizes our client’s audit tools (Recovery Management System (RMS), COB Tracker, specific client systems) to complete member investigations.
• Creates detail-oriented, accurate notes in our client’s 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 our client’s policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Demonstrates a deep understanding of the healthcare industry and a track record of delivering exceptional 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.

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