Senior CMS and OPL Specialist

Capital Health Plan•Tallahassee, FL

19h•Onsite

About The Position

Capital Health Plan is seeking a Senior CMS and OPL Specialist to join our team in Tallahassee, FL, in a full-time position. This role involves overseeing Medicare Secondary Payer and Coordination of Benefits activities, ensuring accurate Section 111 reporting, reconciling CMS and Medicare Advantage files, maintaining ESRD and COB records, analyzing member enrollment and payment data, responding to governmental and recovery demands, investigating insurance liability questions, and collaborating with various departments to ensure accuracy, compliance, and optimal benefit coordination. The company is a not-for-profit health care organization serving the panhandle since 1982, dedicated to high-quality, affordable, and patient-centered care in a professional, respectful, and inclusive workplace.

Requirements

Associate degree or equivalent combination of education and experience
Related experience in healthcare, insurance, claims, COB, MSP, or compliance functions
Knowledge of HIPAA requirements, state insurance laws, federal MSP laws, and regulations
Strong analytical, problem-solving, and organizational skills
Proficiency with Microsoft Word and Excel
Ability to interpret regulations, prepare reports, and communicate effectively
Exceptional attention to detail and relationship-building skills
Basic math skills
Ability to occasionally lift and/or move up to 25 lbs

Responsibilities

Oversee Medicare Secondary Payer and Coordination of Benefits activities
Ensure accurate Section 111 reporting
Reconcile CMS and Medicare Advantage files
Maintain ESRD and COB records
Analyze member enrollment and payment data
Respond to governmental and recovery demands
Investigate insurance liability questions
Collaborate with Finance, Utilization Services, Member Services, and other departments to ensure accuracy, compliance, and optimal benefit coordination