TPL & Coordination of Benefits Analyst

2 days ago

Baton Rouge, Louisiana, United States The University of New Orleans Full time
Job Summary

The University of New Orleans is seeking a highly skilled TPL & Coordination of Benefits Analyst to join our team. As a key member of our staff, you will be responsible for coordinating benefits between Medicaid and other primary insurance sources.

Key Responsibilities
  • Respond to provider, health plan, and member phone calls and correspondence related to the coordination of benefits.
  • Investigate billing and payment issues, including denied claims for members with other primary insurance sources.
  • Assist with matters related to Third Party Liability (TPL) and Medicare billing, including researching and staying up-to-date on CMS mandated changes.
  • Develop and implement TPL policies and procedural changes.
  • Assist in the creation and maintenance of Health Plan Advisories and Informational Bulletins published by LDH related to TPL and Medicare billing.
  • Ensure contract language between the State Medicaid agency and the Managed Care Organization (MCO) dictates the terms and conditions under which the MCO assumes TPL responsibility.
  • Assist with oversight of TPL administration and performance activities.
  • Update the State's federally mandated Third Party Liability Action Plan as necessary.
  • Assist with TPL file monitoring activities.
  • Assist with the planning, coordination, and execution of Medicaid TPL Subcommittee meetings.
  • Monitor contract deliverable compliance for both TPL recoveries and file maintenance activities.
  • Assist with Request for Proposal development and contract negotiations.
  • Responsible for reporting TPL Key Performance Indicators.
  • Assist with TPL Quarterly Financial Reporting with LDH Fiscal Department.
  • Work effectively and communicate clearly with providers, members, Medicaid staff, contractors, and third-party insurance sources.
Qualifications
  • Bachelor's degree or 6 years' professional experience in lieu of degree.
  • Minimum 2 years of professional experience working with Medicare and/or private insurance claims.
  • Excellent analytical, organizational, communication, and time management skills.
  • Strong verbal and written communications skills and ability to communicate technical concepts to technical and non-technical audiences.
  • Great attention to detail and follow-up.
Desired Qualifications
  • Advanced degree.
  • Minimum 3 years of professional experience working with Medicare and/or private insurance claims.
  • Minimum 1 year of professional experience monitoring contracts for deliverable compliance.
  • Professional experience in healthcare billing.
  • CPT, ICD 10 coding, and HCPCS knowledge.
Required Attachments

Please upload the following documents in the Resume/Cover Letter section:

  • Detailed resume listing relevant qualifications and experience.
  • Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems.
  • Names and contact information of three references.
  • Diversity Statement (required for all Faculty positions and any Staff position of Assistant Manager and higher).

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