Benefits Coordinator Specialist
4 days ago
The primary 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.
Key Responsibilities:- Claims Analysis and Processing: Analyze, process, research, and adjudicate claims that involve other insurance carriers.
- COB Claims Management: Process and monitor COB claims according to CMS guidelines.
- Member and Provider Communication: Investigate members for other insurance through phone calls and correspondence, but not limited to claim adjustment requests or appeals.
- Documentation and Follow-up: Responsible for sending and monitoring questionnaires/letters sent to members and providers.
- Timely Processing: Responsible for timely processing of COB claims.
- Quality Standards: Maintain quality standards in all research and adjustment functions.
- Data Entry and Verification: Enter claims or verify data entry for accuracy and completeness.
- Policy and Procedure Adherence: Use online policies and procedures to ensure accuracy in claims processing.
- Liaison and Communication: Act in liaison to providers and members for special claims handling.
- Team Collaboration: Contribute to team effort by accomplishing related results as needed.
- Effective Communication: Communicate effectively with other professional and support staff in order to achieve positive customer outcomes.
- Compliance and Confidentiality: Comply with company policies and procedures and maintain confidentiality of customer medical records in accordance with state and federal laws.
- Regulatory Compliance: Ensure compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
- Professional Development: Participate in meetings, training, and in-service education, as required.
- Additional Responsibilities: Perform other duties as assigned.
- Excellent Communication Skills: Excellent oral and written communication skills
- Health Claims Experience: 1 – 3 years of health claims processing experience
- COB and MSP Knowledge: Working knowledge of COB and MSP preferably
- Medical Terminology: Working knowledge of medical terminology
- Regulatory Knowledge: Working knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA, and other federal and state regulatory guidelines.
- Organizational Skills: Excellent organizational skills
- Pressure Management: Ability to work well under pressure in difficult situations
- Bilingualism: Bilingual: English / Spanish (Required)
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