Claims COB Analyst

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. Analyze members with other insurance coverage to determine the correct order of benefits. Audit claims to identify services paid as primary in error. Analyze COB claims to determine correct claim payment. Research and validate other insurance coverage with insurance carriers. Support vendor oversight of COB recovery-related activities. Coach/mentor team members regarding opportunities for identification of COB. Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality. Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork. Maintain required compliance with privacy and confidentiality standards. Maintain or exceed all established standards for performance, quality, and timeliness. Support the Claims department in the review, investigation, and research of claims issues. Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures. Assist with other related work responsibilities as requested. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.

Requirements

Minimum three years professional experience in claims analysis, provider medical billing, or medical coding; experience with Texas Medicaid preferred.
Minimum two years professional experience with Coordination of Benefits, including order of benefit determination and payment calculation; experience with Texas Medicaid preferred
Minimum High school graduate or GED required

Responsibilities

Analyze members with other insurance coverage to determine the correct order of benefits.
Audit claims to identify services paid as primary in error.
Analyze COB claims to determine correct claim payment.
Research and validate other insurance coverage with insurance carriers.
Support vendor oversight of COB recovery-related activities.
Coach/mentor team members regarding opportunities for identification of COB.
Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality.
Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork.
Maintain required compliance with privacy and confidentiality standards.
Maintain or exceed all established standards for performance, quality, and timeliness.
Support the Claims department in the review, investigation, and research of claims issues.
Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.
Assist with other related work responsibilities as requested.