Senior Payment Accuracy Specialist (COB)

Senior Payment Accuracy Specialist (COB) Job Locations US-Remote Category Audit - Healthcare Position Type Full-Time Overview: A Payment Accuracy, Coordination of Benefits (COB) Senior Specialist, 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. Individuals in the Senior Specialist role are passionate about what they do and are subject matter experts (SMEs) at identifying opportunities for strategic growth, reviewing, discovering, and validating substantial amounts of data, to deliver results and insights for our clients. The Payment Accuracy, Coordination of Benefits (COB) Senior Specialist is a subject matter expert (SME) which encompasses knowledge of all levels of auditing from low to complex situations. Additionally, this individual will hold many responsibilities including but not limited to acting as a mentor to other members of the team and developing and facilitating audit enhancements. Supports an expanding portfolio-wide impact to cross-audit concepts in strategy dissemination and implementation to identify optimizations. Responsibilities: This individual will work with a high degree of autonomy including independent thinking and responsibility for individual workflow and assignments. Acts as a mentor to all team members within the Business Unit. May assist with new hire onboarding and training of employees within the Business Unit. Collaborates when available with all levels of the business upon assigned projects and deliverables. Produces knowledge as a Subject Matter Expert (SME) in a multi-functional aspect for auditing as well as business optimization and innovation. Responsible for a portfolio-wide impact for the entirety of the business units and client partnerships. Develop and facilitates audit enhancements of new tools to aid in team members' ability to perform their assigned responsibilities within the databases. Optimization to innovate new opportunities and discovery of the business, new concepts, recoveries, and the growth of the overall Business Unit. Multi-functional in strategizing, disseminating, and implementing cross-audit concepts. Performs quality control to thoroughly validate submissions prior to Client exportation of team members and own work outputs. Understands Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish correct order of liability. Has the ability to independently member select in Cotiviti tools, with a full understanding of client parameters. Demonstrates subject matter expert level of understanding of query and filter construction to identify opportunities. Demonstrates high level of organization and can pivot as needed per the business requirements. 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. Identify and solve problems by identifying errors and overpayments for our healthcare clients. Learn and use multiple computer software, systems, and technology. Identifies opportunities for continuous improvement for...

Created: 2026-03-08