COB Specialist

Regal Medical Group•Los Angeles, CA

2d•$25 - $27

About The Position

This position is directly responsible for researching and maintaining coordination of benefits of all contracted and non contracted health plan entities as reported by any health plan, provider, Medicare, TPL, Workers Comp or internal departments. They are to ensure that all EZ-Cap system eligibility data is current and accurate. Researches and maintains systems and changes to existing eligibility in a timely manner.

Requirements

Three years office experience in Managed Health Care
Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans
Must have knowledge of the Department of Managed Healthcare COB guidelines
Experience with Windows, Microsoft Office programs, and Outlook
Experience in Customer Service
Must multitask and be organized
Should posses an A.A. in Business Administration
Good verbal and written communication skills.
Computer literate with keyboard skills for data entry.

Nice To Haves

Knowledge of EZ-Cap preferred.
A bachelor’s degree from a four-year college or appropriate industry experience and/or certification.

Responsibilities

When a COB requests are received from internal departments and corporate employee will determine if the health plan and CMS reflect correct COB information.
Staff will contact the health plan and verify if the policy is an active employer group policy (large or small) or a retiree policy and obtain a retiree date.
Staff will contact the member to confirm their employer group status, active or retired. (Only when the health plan cannot confirm a retiree date, number of employees or any other pertinent information necessary to establish COB according to Medicare guidelines).
Staff will notify the employer group to advise them the health plan shows member actively employed, when per the member, they are retired.
Review Medicare guidelines to determine if they have obtained all the necessary information from the health plan, employer group, or member to establish correct COB.
Contact the CMS COB unit to report that there is or there is no COB if CMS shows Medicare Secondary Payer information.
Document in EZ-Cap in the notes field of all activity, calls, CMS MSP status, etc. and respond to appropriate departments of any changes in coordination of benefits.
Update COB field in EZ-Cap to reflect correct MSP status according to Medicare guidelines even when CMS & health plan do not yet reflect correct MSP.
Follow up with CMS and the health plan in 5 to 10 business days to verify information has been update by both CMS and the health plan. (Continue to follow up with CMS, health plan and member if necessary).
Communicates verbally and supplies a summary of COB status at weekly Membership meetings. Is responsible of educating staff and keeping up with changes in Medicare guidelines.
Maintains End Stage Renal Disease Database. Communicates ESRD updates to all appropriate departments.
Performs research and analysis of membership
Enters new member eligibility records into EZ Cap in accordance with established guidelines.
Uses activity analysis reports from the health plans to make changes to existing enrollees; i.e. benefit option changes, terminations, and address changes.
Manually audits existing eligibility in EZ Cap against current eligibility.
Investigates retroactive cancellations for services rendered by the member after the policy termination date for eligibility guarantee.
Researches problem eligibility on authorizations and/or claims forms by calling the health plans or utilizing any other source to resolve the problem.
Assists personnel from other departments with eligibility issues.
Monitors queue, web site and email for inquiries. Responds timely to membership inquiries.
All other duties as directed by management.