Coordination of Benefit Representative - Hybrid - Orange County

Alignment Healthcare•Orange, CA

3d•Hybrid

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This position is Hybrid - You must live in Orange County. The Coordination of Benefit Representative assists in the day-to-day responsibilities of the various sections within the Membership Unit. The Representative ensures that all of the COB and MSP files from CMS are properly loaded in EZ-Member, as well as coordinating of benefits between AHP and other coverage.

Requirements

Minimum 3 years direct customer service experience.
Minimum one year of direct sales or related experience.
High School Diploma or GED.
Basic knowledge of Medi-Cal and Medicare Advantage Prescription Drug Plans.
MARX
Must be familiar with CMS MMR and TRR files
Basic Computer Skills, 40 WPM (Microsoft Outlook, excel, word)
10-Key by Touch
Direct handling and processing of CMS enrollments and disenrollment applications.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
Ability to write routine reports and correspondence.
Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Nice To Haves

Healthcare, Insurance or Managed Care industry experience
college courses
Bilingual (English/Spanish)

Responsibilities

Uploads daily files from CMS into EZ- Member.
Updates and deletes members other coverage through COB contractor via ECRS.
Ensures members file is flagged with the proper coverage. (primary or secondary)
Ensures all COB data is transferred into EZ-Cap.
Responsible for surveying current members with other coverage on a yearly basis as well as new members.
Collaborates with I.T. on creating reports and any system updates as per CMS guidelines.
Collaborates with the Claims Department on other coverage discrepancies or updates.
Contacts other insurances to verify members’ coverage or members to obtain proof of coverage.
Updates COB/ MSP policy and standard operation procedures (SOP) as needed.
Collaborates with the Eligibility Department on coverage discrepancies.
Assists in the day-to-day activities for any section within the Membership Unit. The responsibilities are to provide support including any of the following, filing, typing, data entry, and mailing of various forms of communications to our members. As well as outbound calls, the sending of facsimiles and/or e-mail communications.
Assists in the processing the Weekly Transaction Reply Report (TRR) and Monthly TRR. Mailing of weekly and monthly notification of letters to the members and ensure proper documentation is added in EZ-Member.
Other duties as assigned.