Current jobs related to Coordination of Benefits Representative - Somerville - Mass General Brigham Health Plan
-
Prevention Services Coordinator
1 week ago
Somerville, Massachusetts, United States City of Somerville Full timeJob SummaryWe are seeking a highly skilled Prevention Services Coordinator to join our team at the City of Somerville. The successful candidate will support the Director of Prevention Services in a variety of prevention-focused initiatives, including managing and coordinating regional planning, budgeting, implementation, and evaluation phases of activities...
-
Client Services Coordinator
1 month ago
Somerville, Massachusetts, United States City of Somerville Full timeJob OverviewThe Client Services Manager plays a pivotal role in the Office of Housing Stability (OHS), working closely with the Deputy Directors to oversee the direct services aspect of the organization. This position is essential in ensuring that residents receive exceptional services. The Client Services Manager will directly supervise case management...
-
Homelessness Contracts Coordinator
14 hours ago
Somerville, Massachusetts, United States City of Somerville Full timeJob Title: Homelessness Contracts CoordinatorJoin the City of Somerville's Health and Human Services department as a Homelessness Contracts Coordinator, a newly created position in the Prevention Services Division. This role serves as the liaison and contract coordinator for service providers in the City of Somerville and other related contracts, providing...
-
Urban Planning Coordinator
1 month ago
Somerville, Massachusetts, United States City of Somerville Full timeJob OverviewThe City of Somerville is seeking a dedicated Urban Planning Coordinator to oversee and facilitate the permit administration process. This role involves providing expert guidance to various Boards and Commissions, acting as a key planner and liaison, and delivering professional planning services that encompass research, analysis, and effective...
-
Safety and Compliance Coordinator
1 month ago
Somerville, Massachusetts, United States City of Somerville Full timeJob OverviewThe Safety and Compliance Coordinator plays a pivotal role in overseeing the safety, health, and training initiatives within the Water and Sewer Department.Key Responsibilities:The following duties are representative of the various tasks that may be undertaken. The absence of specific tasks does not exclude them from the role if they are similar...
-
Client Services Coordinator
1 month ago
Somerville, Massachusetts, United States City of Somerville Full timeJob OverviewThe Client Services Manager plays a pivotal role in the Office of Housing Stability (OHS), working closely with the Deputy Directors to oversee the management of direct service operations. This position is essential in ensuring that residents receive exemplary support and services.Key ResponsibilitiesThe following duties illustrate the range of...
-
VITA Site Coordinator
2 months ago
Somerville, United States Community Action Agency of Somerville Full time $37Job DescriptionJob DescriptionJob Title: VITA Site Coordinator Supervisor: Director of FinanceHours: 10-15 average hours per week over designated evenings and weekends FLSA: Non-ExemptHourly Rate: $37.83/hourStatus: Part-time, temporary OVERVIEW The Volunteer Income Tax Assistance (VITA) Program provides free income tax preparation for ...
-
VITA Site Coordinator
3 weeks ago
Somerville, Massachusetts, United States Community Action Agency of Somerville Full timeJob Title: VITA Site CoordinatorJob Summary:The Community Action Agency of Somerville is seeking a highly organized and detail-oriented VITA Site Coordinator to oversee the daily operations of our Volunteer Income Tax Assistance (VITA) site. As a VITA Site Coordinator, you will be responsible for ensuring the smooth operation of the site, providing support...
-
Associate Financial Representative
4 months ago
Somerville, United States Modern Woodmen of America Full timeOverview The Modern Woodmen – Somerville office is seeking a motivated and driven individual to join our team as an Associate Financial Representative. This role offers an opportunity to partner with a respected local business and work alongside the Managing Partner and Senior Financial Representative. The ideal candidate will maintain existing...
-
Associate Financial Representative
4 months ago
Somerville, United States Modern Woodmen of America Full timeOverview The Modern Woodmen – Somerville office is seeking a motivated and driven individual to join our team as an Associate Financial Representative. This role offers an opportunity to partner with a respected local business and work alongside the Managing Partner and Senior Financial Representative. The ideal candidate will maintain existing...
-
Associate Financial Representative
6 days ago
somerville, United States Modern Woodmen of America Full timeOverview The Modern Woodmen – Somerville office is seeking a motivated and driven individual to join our team as an Associate Financial Representative. This role offers an opportunity to partner with a respected local business and work alongside the Managing Partner and Senior Financial Representative. The ideal candidate will maintain existing...
-
Nurse Coordinator
7 days ago
Somerville, Massachusetts, United States Mass General Brigham Full timeJob Title: Nurse CoordinatorMass General Brigham is seeking a highly skilled and compassionate Nurse Coordinator to join our team. As a key member of our Pediatric Gastroenterology Division, you will provide exceptional nursing care to patients and families, while also coordinating the nursing program and activities for the division.Key...
-
Patient Services Representative
1 day ago
Somerville, Massachusetts, United States RWJBarnabas Health Full timeJob Title: Patient Services RepresentativeWe are seeking a highly organized and detail-oriented Patient Services Representative to join our team at RWJBarnabas Health. As a Patient Services Representative, you will play a critical role in ensuring the smooth operation of our medical office, providing exceptional patient care and support to our patients and...
-
Patient Services Representative
4 days ago
Somerville, Massachusetts, United States RWJBarnabas Health Full timeJob Title: Patient Services RepresentativeWe are seeking a highly organized and detail-oriented Patient Services Representative to join our team at RWJBarnabas Health. As a key member of our healthcare team, you will be responsible for ensuring patient satisfaction and efficient operations.Key Responsibilities:Prepare for patient visits, triage practice...
-
Key Accounts Coordinator
2 days ago
Somerville, United States Marcolin Full timeThe key accounts customer service representative is responsible for order entry processing, modifications, and release. They Monitor customer orders, backorders and shipping windows. This will entail professional interaction, by phone and written correspondence, with sales representatives, retailers, buyers and customer contacts.Essential Duties and...
-
Student Safety Coordinator
4 weeks ago
Somerville, Massachusetts, United States City of Somerville Full timeStudent Safety Coordinators play a vital role in maintaining public safety by facilitating secure crossings for students at critical intersections on their way to educational institutions. Comprehensive uniforms and training will be provided. Advantages of working as a Student Safety Coordinator include:$50 referral incentive for current coordinators who...
-
Benefits Administrator
2 weeks ago
Somerville, Massachusetts, United States Mass General Brigham Full timeJob SummaryWe are seeking a highly skilled Benefits & Coding Administrator to join our team at Mass General Brigham Health Plan. This role will play a critical part in supporting the accurate and effective implementation of benefits across all products.Key ResponsibilitiesEvaluate benefit configuration in collaboration with IT Configuration and Claims staff...
-
Clinical Coordinator
2 days ago
Somerville, Tennessee, United States The Omni Family of Services Full timeJob Title: Wilder Clinical CoordinatorJob Summary:The Omni Family of Services is seeking a highly skilled and compassionate Clinical Coordinator to join our team at the Wilder Youth Development Center. As a key member of our staff, you will work directly with youth and their families to create supportive and encouraging relationships, promoting a culture of...
-
Nurse Coordinator
1 week ago
Somerville, Massachusetts, United States Mass General Brigham Full timeJob DescriptionMass General Brigham is seeking a highly skilled Nurse Coordinator to join our team in Somerville, Massachusetts.The successful candidate will be responsible for assisting in quality improvement and safety event reviews, collecting data for purposes of quality and safety process improvement programs, and investigating and analyzing critical...
-
Benefits Manager
7 days ago
Somerville, Massachusetts, United States City of Somerville Full timeJob SummaryWe are seeking a highly skilled Benefits Manager to oversee the City of Somerville's employee benefits programs. The successful candidate will be responsible for ensuring that the benefits offered are cost-effective, affordable, and meet the needs of City and School employees, and retirees.Key ResponsibilitiesOversee the management of the City's...
Coordination of Benefits Representative
4 months ago
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Coordination of Benefits Representative will be responsible for investigating potential recoveries for COB through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This person will also be responsible for management of communications with internal and external customers, and high level of research work related to coordination of benefits opportunities. Deals directly with providers, members, CMS and other health plans in state and nationally regarding laws and statutes governing COB.
ESSENTIAL FUNCTIONS
Responsible for identifying recovery opportunities within the COB/TPL Department.
Review, research and process all COB claims for members with other insurance, including retractions and repayments according to desktop procedures, contractual requirements and other regulatory rules.
Responsible for reprocessing claims for COB termed members and ensure information is added and maintained accurately in QNXT.
Process and log all recoveries received from outside insurance companies.
Responsible for phone calls to or from members, providers, and other insurance companies to gather or provide coordination of benefits data.
Responsible for reviewing, researching and resolving email inquiries from internal customers regarding member's claims and/or eligibility updates.
Responsible for researching Medicare benefits questions and guidelines to assist providers and members in claim processing. Demonstrate and apply knowledge of Medicare and CMS processes and procedures.
Responsible for reviewing, researching and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to group and Sales Team when needed.
Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
Validate and process MassHealth and vendors' monthly reports to identify COB claims.
Maintain and update accurate COB information in QNXT for reporting to MassHealth and other customers as needed.
Responsible for processing COB correspondence via mail or faxes.
Work in collaboration with the Compliance Department at MGB Health Plan to ensure recoveries are received timely.
Process COB questionnaires to members and make determination of primary insurance in accordance with federal and state mandates.
Process Credit Balance claims, refunds checks, and validate claims retractions.
Responsible for reviewing projects or reports of members with other insurances. This includes flagging members with COB information.
Meets monthly and quality claims processing production metrics as well as quality assurance metrics established in the department.
Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
Other duties as assigned with or without accommodation.
Qualifications
KNOWLEDGE AND EDUCATION
Required:
High School diploma or GED is required.
Preferred/Desired:
Associate's Degree or the equivalent combination of training and experience is preferred.
Knowledge in working with third party payors.
Knowledge of the MSP process.
EXPERIENCE
Required:
2-4 years of related experience in the COB/TPL or other HealthCare related field.
Must be proficient in Microsoft Word, and Excel.
Proficient PC skills including familiarity with Microsoft Access.
Preferred/Desired:
Knowledge of ICD-9, CPT & HCPC coding or equivalent experience.
SKILLS/COMPETENCIES
The successful candidate will possess strong customer service skills, knowledge of medical terminology, excellent communication skills, and be able to multi-task and prioritize. In addition, you must have problem solving skills and be highly organized.
Demonstrates MGB Health Plan Core Values of Service Excellence, Quality Care, Diversity, Responsibility and Relationships.
Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner.
Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
Accountable for delivering high quality work.
OTHER SKILLS
Negotiation and conflict resolution skill
EEO Statement
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.
