Benefits Coordinator

UHS•Reno, NV

11h

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The Benefits Coordinator (Revenue Project Coordinator - COB) will focus on Medicare Secondary Payer (MSP) claims, Coordination of Benefits (COB) claims, and medical coverage overlaps with other insurance carriers to ensure accuracy of claims payments. Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare. Reviews cases to determine primary liability when not established. Maintains system information regarding coverage overlaps and primacy to ensure correct coordination occurs with Medicare. Research claims history to identify previously paid claims for recovery.

Requirements

High School diploma; Bachelor’s degree preferred
2-4 years of related experience in COB/TPL or other healthcare related field
Advanced SQL skills to aid in identification of cases to be worked
Knowledge in working with third party payers
Knowledge of the MSP process
Program and Project Management skillset
Capable interpersonal skills to easily establish rapport with provider office staff
Self-starter with an ability to work autonomously, managing own workload to drive results
Highly organized with attention to detail
Demonstrated ability to follow through on project work
Able to learn key concepts and processes quickly
Microsoft Office proficient (Excel, Word, Outlook) and/or Smartsheet
Resourceful with ability to find and optimize additional revenue

Responsibilities

Focus on Medicare Secondary Payer (MSP) claims, Coordination of Benefits (COB) claims, and medical coverage overlaps with other insurance carriers to ensure accuracy of claims payments.
Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare.
Review cases to determine primary liability when not established.
Maintain system information regarding coverage overlaps and primacy to ensure correct coordination occurs with Medicare.
Research claims history to identify previously paid claims for recovery.
Performs other duties as assigned or required.