Senior Payment Accuracy Specialist (COB)
J
JobgetherHealthcare Payment Accuracy
Based in the United StatesFull-TimeSenior
Salary$37.75 to $39.50 per hour
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of five years of related healthcare industry experience
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- High school diploma required; bachelor’s degree preferred.
- Minimum of five years of related healthcare industry experience, including knowledge of Coordination of Benefits processes.
- Experience with healthcare auditing, payment accuracy, claims review, or recovery operations.
- Strong understanding of healthcare regulations, including CMS and NAIC guidelines.
- Experience working with large datasets, databases, and analytical tools.
- Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
- Experience using audit platforms and healthcare technology systems is preferred.
- Strong written and verbal communication skills with the ability to explain complex information clearly.
- Ability to work independently, manage multiple priorities, and deliver results in a fast-paced environment.
- Strong problem-solving skills with the ability to identify opportunities and recommend improvements.
- Detail-oriented approach with strong organizational skills and commitment to quality.
- Ability to maintain confidentiality and follow HIPAA and data security requirements.
- Must have a dedicated, secure remote workspace with reliable high-speed internet connectivity.
Responsibilities
- Conduct advanced Coordination of Benefits (COB) audits to identify payment accuracy opportunities, recoveries, and potential overpayments for healthcare clients.
- Serve as a subject matter expert on audit processes, healthcare regulations, and optimization strategies across the business unit.
- Independently manage assigned workflows, investigations, and projects while prioritizing changing business needs.
- Analyze large datasets, develop insights, and identify trends that support strategic decision-making and operational improvements.
- Utilize audit platforms, databases, and client systems to perform member investigations and document findings accurately.
- Apply knowledge of CMS and NAIC guidelines to determine appropriate order of liability and ensure compliance.
- Perform quality control reviews to validate audit submissions and ensure accuracy before client delivery.
- Develop and facilitate audit enhancements, process improvements, and innovative solutions that improve team efficiency.
- Mentor team members, support onboarding activities, and share best practices to strengthen overall team capabilities.
- Collaborate with internal stakeholders and client partners on projects, disputes, reporting, and business initiatives.
View Full Description & ApplyYou'll be redirected to the employer's site
