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.
Investigatesmembersforotherinsurancethroughphonecallsand 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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Numbers & Facts
Location
Coral Gables, FL
Skills
Adjudicationunmatched
American Health Care Association (AHCA)unmatched
Centers for Medicare and Medicaid Services (CMS)unmatched
Claims Processingunmatched
Communication Skillsunmatched
Content Management Systems (CMS)unmatched
Data Entryunmatched
Data Qualityunmatched
Develop and Maintain Customersunmatched
Employment Contractsunmatched
English Languageunmatched
Federal Laws and Regulationsunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Health Planunmatched
Insuranceunmatched
Maintain Complianceunmatched
Medical Recordsunmatched
Medical Terminologyunmatched
Medical Treatmentunmatched
Medicareunmatched
Multilingualunmatched
OSHAunmatched
Operations Guidelinesunmatched
Organizational Skillsunmatched
Patient Confidentialityunmatched
Presentation/Verbal Skillsunmatched
Process Analysisunmatched
Quality Managementunmatched
Quality Metricsunmatched
Regulationsunmatched
Spanish Languageunmatched
State Laws and Regulationsunmatched
Time Managementunmatched
Writing Skillsunmatched
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