TPL & Coordination of Benefits Analyst

University of New Orleans•Baton Rouge, LA

2d•$60,000 - $70,000

About The Position

This position is responsible for responding to provider, health plan, and member inquiries regarding the coordination of benefits between Medicaid and other primary insurance sources. The role involves investigating billing and payment issues, particularly for denied claims of members with other primary insurance. It also includes assisting with Third Party Liability (TPL) and Medicare billing, staying updated on CMS-mandated changes, and aiding in the development and implementation of TPL policies and procedural changes. The analyst will help create and maintain Health Plan Advisories and Informational Bulletins, ensure contract language dictates TPL responsibility, and assist with oversight of TPL administration and performance by Managed Care Organizations. Additionally, the role involves updating the federally mandated Third Party Liability Action Plan, assisting with TPL file monitoring, planning and executing TPL Subcommittee meetings, monitoring contract deliverable compliance for TPL recoveries and file maintenance, assisting with Request for Proposal development and contract negotiations, reporting TPL Key Performance Indicators, and assisting with TPL Quarterly Financial Reporting. Effective communication with providers, members, Medicaid staff, contractors, and third-party insurance sources is essential, along with performing other directed tasks.

Requirements

Bachelor’s degree or 6 years’ professional experience in lieu of degree.
Minimum 2 years of professional experience working with Medicare and/or private insurance claims.
Excellent analytical, organizational, communication and time management skills.
Strong verbal and written communications skills and ability to communicate technical concepts to technical and nontechnical audiences.
Great attention to detail and follow up.

Nice To Haves

Advanced degree.
Minimum 3 years of professional experience Medicare and/or private insurance claims.
Minimum 1 year of professional experience monitoring contracts for deliverable compliance.
Professional experience in healthcare billing.
CPT, ICD 10 coding and HCPCS knowledge.

Responsibilities

Responds to provider, health plan, and member phone calls and correspondence related to the coordination of benefits between Medicaid and other primary insurance sources.
Investigates billing and payment issues including but not limited to denied claims for members with other primary insurance sources.
Assists with matters related to Third Party Liability (TPL) and Medicare billing, including researching and staying up-to-date on any CMS mandated changes for TPL and Medicare billing that would impact Louisiana Medicaid.
Assists in the development and implementation of TPL policies and procedural changes.
Assists with the creation and maintaining of Health Plan Advisories and Informational Bulletins published by LDH related to TPL and Medicare billing.
Ensures the contract language between the State Medicaid agency and the Managed Care Organization (MCO) dictates the terms and conditions under which the MCO assumes TPL responsibility.
Assists with oversight of TPL administration and performance activities that are the responsibility of the State’s Managed Care Organizations and are clearly defined.
Updates the State’s federally mandated Third Party Liability Action Plan as necessary to maintain currency of Louisiana Medicaid COB/TPL practices.
Assists with TPL file monitoring activities as needed.
Assists with the planning, coordination, and execution of Medicaid TPL Subcommittee meetings.
Monitors contract deliverable compliance for both TPL recoveries and file maintenance activities.
Assists with Request for Proposal development and contract negotiations.
Responsible for reporting TPL Key Performance Indicators.
Assists with TPL Quarterly Financial Reporting with LDH Fiscal Department.
Works effectively and communicates clearly with providers, members, Medicaid staff, contractors, and third party insurance sources.
Other tasks as directed.