COB Coordinator

Independent Health Association•Buffalo, NY

1d•$19 - $21

About The Position

The Coordination of Benefits (COB) Coordinator will be responsible for all duties listed under the COB Assistant position and will serve as the primary contact for incoming COB related claims, correspondence and other investigative needs. The COB Coordinator will also be responsible for claims adjudication, performing basic claim adjustments and working defined reports. The COB Coordinator shall determine and interpret basic COB information as it relates to Independent Health’s obligation for claim payment for all insured lines of business by adhering to New York State Rules and Regulations, NAIC Guidelines, Independent Health policies, summary plan descriptions, member contracts, and Centers for Medicare and Medicaid Services (CMS) guidelines as applicable. The COB Coordinator will be expected to work independently and demonstrate strong problem-solving and decision-making skills while maintaining an acceptable level of production and performance as outlined in the Claims/COB Performance Management SOP. This role will also carry out the necessary investigation of basic COB concepts, other insurance, diagnosis of potential workers’ compensation, motor vehicle accidents, liabilities, assistant reports, as well as processing basic Siebel service requests and Health Rules workbasket follow up items for both individual and department queues. This position will also be responsible for achieving departmental savings targets associated with coordination of benefits, which contribute to the overall organizational savings plan and medical loss ratio.

Requirements

High school diploma or GED required.
Minimum of one (1) year of prior experience working in claims or healthcare operations required.
Strong verbal, written and interpersonal communication skills, with proven customer service skills required.
Proficiency with data entry skills and Microsoft Office (Word, Excel) products required.
Experience with independent decision making to include effective problem resolution.
Assume responsibility and adhere to departmental deadlines and turnaround times, to be compliant with state and federal regulations.
Strong organizational skills with attention to detail and follow through.
Ability to work collaboratively within and outside of the department.
Ability to meet or exceed all department goals to include accuracy, productivity and savings goals.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Associates degree preferred.
Experience with coordination of benefits preferred.
Experience with claims concepts or secondary payer processes and procedures preferred.
Experience applying COB concepts while consulting NYS Rules and Regulations, NAIC Guidelines and CMS Guidelines is preferred.
Knowledge of CPT codes, ICD-10 coding, and medical terminology preferred.
Experience in navigating multiple systems while interacting with a customer and processing claims.

Responsibilities

Resolve verbal and written correspondence from members, providers, benefit managers, attorneys, other insurance companies, regulatory agencies (i.e. Centers of Medicare and Medicaid) and internal departments effectively.
Identify and perform appropriate customer outreach to ensure accuracy and completion of member records and claim payments. This may include providing education of Independent Health’s COB processes and policies to these parties.
Document all communication with customers in the Independent Health communication and documentation systems. All activity will comply with departmental turnaround times and NYS prompt pay deadlines.
Capacity to independently investigate the potential for other party liability to include but not limited to other commercial insurance, Medicare, Workers’ Compensation, No-Fault, Liens and Liabilities.
Verbal and written communication with members, providers, attorneys, benefit managers, and other insurance companies to accurately identify Independent Health responsibility for primary claims payment.
Retain technical knowledge of Independent Health’s customer documentation and claims processing systems accordingly to review and maintain member records, as well as examine and adjudicate claims and adjustments based on defined standard operating procedures.
Identify and assist with the development and implementation of process improvements to create efficiencies within the department.
Knowledge of Microsoft Word/Excel to work reports and complete production logs.
Meet all key performance indicators and accountabilities as defined by the department performance management SOP.
Meet department accuracy, production, and departmental savings targets as set by COB leadership.
Generate appropriate COB letters to the member, provider, and employer group within established time frames.