Coordination of Benefits Specialist
| Company | Healthfirst |
|---|---|
| Location | New Mexico, USA, Washington, USA, Kansas, USA, Pennsylvania, USA, North Dakota, USA, Wyoming, USA, Texas, USA, Montana, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, South Dakota, USA, Georgia, USA, Arizona, USA, Concord, NH, USA, Mississippi, USA, Tennessee, USA, Minnesota, USA, Colorado, USA, Utah, USA, Northeastern United States, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Oklahoma, USA, Louisiana, USA, Alabama, USA, United States |
| Salary | $49795 – $76960 |
| Type | Full-Time |
| Degrees | Associate’s |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- High School Diploma OR GED from an accredited institution.
- Work experience demonstrating oral and written communication skills.
- Health insurance claims processing, COB or related experience
- Experience speaking directly with providers and provider billing offices regarding claims issues
- Basic understanding and experience working with document imaging and workflow routing systems.
- Experience with PC applications and ability to toggle between multiple systems or applications entering data in multiple fields
- Experience with Microsoft Office suite of applications including Outlook and Excel with ability to create and use Excel reports to efficiently manage information by using features such as search/find, sort/filter, formatting/filtering, inserting columns/rows/field and creating additional worksheets/tabs.
Responsibilities
- Identify members who have additional coverage and update company systems
- Initiate outbound calls to members and/or other primary insurers to validate insurance coverage, update all Healthfirst and/or secondary systems (including potentially CMS and State systems which track COB information), and determine primacy of said coverage.
- Initiate subsequent recovery efforts as a result of any validations completed, inclusive of either reprocessing the claims, or submitting the overpayment recovery project through the appropriate channels.
- Serve as a liaison to internal departments that initiate service forms regarding verification of other insurance coverage.
- Work closely with all external vendors who have been contracted to supply Healthfirst with COB related information, inclusive of monitoring file transfers, working the files and taking appropriate corresponding action in Healthfirst systems, and establishing/monitoring controls related to all files/members and claims worked.
- Work with data analysts to appropriately identify overpaid claims as a result of retroactive discovery of COB.
- Maintain daily work-flow and a standard of production with quality and accuracy.
- Respond to any regulatory or compliance requests for information or audits in a timely and accurate manner.
- Support management with reports, special projects, and other duties as assigned.
Preferred Qualifications
- Basic understanding and experience of claim processing knowledge.
- Associates Degree from an accredited institution
- Ability to work under minimal supervision
- Communicate with skill, tact, persuasion and/or negotiation to accomplish the objectives of the communication.