Payment Accuracy COB Specialist

Job Overview

JOB DETAILS

REQUIREMENTS

• High School Diploma – Required.
• Bachelor’s degree (Preferred) and/or a minimum of one (1) year of related experience in healthcare.
• Healthcare industry experience, including knowledge of Coordination of Benefits (Preferred).
• 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 our client’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.

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 our client’s 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 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.
• 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 our client’s 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.

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