Coordination of Benefits Representative, remote
Mass General Brigham Health Plan

Job Info

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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.

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, repayments according to desktop procedures, contractual requirements and other regulatory rules.
• 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 coordination of benefits.
• Research Medicare benefits questions and guidelines to assist providers in claim processing.
• 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.
• Reprocess claims for COB termed members, and ensure information is added and maintained accurately in departmental database.
• Maintain and update accurate COB databases in Microsoft Access for reporting to MassHealth and other customers as needed.
• Responsible for processing COB correspondence via mail or faxes, and refunds checks.
• Work in collaboration with the Compliance Department at NHP to ensure recoveries are received timely.
• Provides explanations and interpretations within area of expertise.
• 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.
• Flag member's records with COB information through various reports.
• Meets claims processing standards.
• 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.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

WORKING CONDITIONS AND PHYSICAL EFFORT
• Work is normally performed in a typical remote office work environment.

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.
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

OTHER SKILLS

• Negotiation and conflict resolution skills

INDEPENDENT ACTION
• Candidate must be able to prioritize work and use independent judgment.

ORGANIZATIONAL RELATIONSHIPS/SCOPE
Deals directly with other payors to coordinate benefits, credit balance vendors, CMS, other health plans in state and nationally according to laws and statutes governing COB, TPL and Medicare regulations.

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 law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

This job has expired.