The Main function of a COB Coordinator is to coordinate benefits between Doctors Healthcare Plans, Inc. and other insurance carriers that may be liable for the services provided to our members.
Responsibilities:
Analyze, process, research and adjudicate claims that involve other insurance carriers
Process and monitor COB claims according to CMS guidelines
Investigates members for other insurance through phone calls and correspondence but not limited to claim adjustment requests or appeals
Responsible for send and monitor questionnaires / letter sent to members and providers
Responsible for timely processing of COB claims
Maintains quality standards in all research and adjustment functions
Enter claims or verify data entry for accuracy and completeness
Uses online policies and procedures to ensure accuracy in claims processing
Acts in liaison to providers and members for special claims handling
Contributes to team effort by accomplishing related results as needed
Communicates effectively with other professional and support staff in order to achieve positive customer outcomes
Promotes and contributes to a positive, problem-solving environment
Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws
Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations
Participates in meetings, training and in-service education, as required
Performs other duties as assigned
Qualifications:
Excellent oral and written communication skills
1 – 3 years of Health claims processing experience
Working knowledge of COB and MSP preferably
Working knowledge of medical terminology
Working knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines
Excellent organizational skills
Ability to work well under pressure in difficult situations
Bilingual: English / Spanish (Required)
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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91TeH6K05W
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
Industries
Internet Publishing
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