Payment Integrity Lead Coordination of Benefits (COB)

Blue Cross Blue Shield • Kansas City, MO

263d

About The Position

The Payment Integrity Lead - Coordination of Benefits (COB) is responsible for inventory management, problem solving complex issues, and ensuring the financial accuracy of Blue KC's Coordination of Benefits program. Focuses leadership in all areas of Blue KC's COB processes including Payer Priority Determination, Complex Claims Resolution, Staff Training and Development, Data Analytics and Reporting, and Vendor collaboration to support COB investigations including partnership with federal and state agencies.

Requirements

• Bachelor's degree in Business Administration, Computer Science or related field; or an equivalent combination of education and experience.
• 5 years of experience with the full life cycle of Coordination of Benefits (COB), Membership or Claims Records, including oversight of vendor contracts and systems.
• Experience with health plan operations including claims payment, payer priority determination, and working with provider offices, other payers and vendor partners.
• Experience with document management software platforms such as Perceptive for inventory management and work assignment.
• Experience with payor claims adjudication systems, including Member and Provider Inquiries.
• Experience handling complex Coordination of Benefits payer priority determinations using external vendor systems including CAQH and Medicare.
• Strong analysis skills to support inventory management, validation of current processes, and development of reporting to support COB program savings.
• Intermediate level knowledge of Microsoft Office.
• Proven ability to manage inventory and resource assignments to meet SLA and turnaround times.
• Proven ability to create and train other team members on current SOP and best practices.

Nice To Haves

• Advanced knowledge of Microsoft Office.
• Advanced knowledge of Facets Claims processing systems or similar claims adjudication platforms.
• Previous experience with Vendor Management and coordination for software support.

Responsibilities

• Identifies areas of improvement and implements proactive solution recommendations partnering with internal and external stakeholders at all levels of the organization.
• Analyzing current COB workflows to identify inefficiencies, develop and implement improvements to streamline claim adjudication and reduce errors.
• Utilizes Medicare expertise in conjunction with strong analytical and collaboration skills to partner with matrix partners and vendors ensuring accurate and timely benefit primacy determination in complex scenarios.
• Investigating and resolving complex COB issues such as coordinating with multiple insurance companies including federal and state programs, to resolve discrepancies.
• Accountable for the annual review of policies and procedures to ensure compliance with current regulatory and industry standards.
• Strong partnerships with claims processing teams, provider relations, IT, and compliance departments to ensure smooth COB integration and adherence to regulations.
• Coaching and mentoring team members and peers ensuring accurate claims adjudication and staying updated on changing industry regulations.
• Training responsibilities include loading COB information into adjudication systems and vendor support programs.

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits.
• 401(k) plan that both the employee and employer contribute.
• Annual incentive bonus plan based on company achievement of goals.
• Time away from work including paid holidays, paid time off and volunteer time off.
• Professional development courses, mentorship opportunities, and tuition reimbursement program.
• Paid parental leave and adoption leave with adoption financial assistance.
• Employee discount program.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree