Provider Maintenance & COB Coordinator

UNITE HERE HEALTH•Oak Brook, IL

19h•$19 - $23•Hybrid

About The Position

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Provider Maintenance and COB Coordinator role is to examine claims data, review and update provider records, including documents needed from providers to ensure accurate claims processing. Determines primacy rules as related to Coordination of Benefits (COB) policy provisions and updates member records accordingly. This position utilizes multiple systems in order to perform the day-to-day functions of maintaining provider records, updating of COB primacy for our members, as well as, provider and member driven inquiries.

Requirements

2 ~ 3 years of related experience in a medical claim adjudication environment, or 2 years in health care or insurance environment
Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
Experience with eligibility verification, medical coding, coordination of benefits and subrogation
Experience with medical terminology, International Classification of Diseases (ICD)10 and Current Procedures Terminology (CPT) codes
High School Diploma or GED
Intermediate level Microsoft Office skills (, Word, Outlook)
Intermediate level Microsoft Excel skills
Communication skills, (verbal and written)
Problem solving, multi-tasking and decision-making skills
Customer service

Nice To Haves

College degree preferred
Intermediate level system(s) skills in Javelina claims system or similar system preferred

Responsibilities

Determines the need for additional information from providers and other insurance carriers to ensure the Fund has complete and accurate records
Effectively search online resources to verify provider information including, but not limited to address verification, provider specialty and National Provider ID (NPI) numbers
Updates and maintains internal Taxonomy Crosswalk database on an as needed basis
Creates and updates provider records within the claims processing system, including W9 forms and related claim denial reports
Professional phone etiquette when contacting providers to request W9 forms or validate provider information
Responsible for working various inventory work items related to provider records and COB updates
Responsible for provider year end activities including CP2100 report and B-notices
Updates COB information within the claims processing system to ensure accuracy of claim payments
Works with internal and external resources to make sure the Fund has the most recent and accurate COB information
Participates in projects related to recurring COB updates, testing and reporting
Responds to all provider and COB related inquiries professionally and timely within established metrics
Responsible for monthly ESRD reports including working closely with the Medical Directorate team
Identifies and reports on trends related to provider or COB functions to mitigate adverse member impact
Meets or exceeds established productivity and quality expectations
Sets goals and achieve measurable results
Contributes ideas to plans and achieving department goals
Exemplifies the Fund’s BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
Performs other duties as assigned within the scope of responsibilities and requirements of the job
Performs Essential Job Functions and Duties with or without reasonable accommodation