COB Representative

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); À distance; USD 30 000 - 44 000; Plein temps

Résumé du poste

Mass General Brigham Health Plan Holding Company, Inc. is seeking a remote COB Recovery Specialist to identify and pursue recovery opportunities for Coordination of Benefits.

You will review and process COB claims, reprocess termed claims in QNXT, and handle inquiries from internal teams regarding claims and eligibility updates. The role requires 2-3 years of COB or third-party liability experience, strong communication and organizational skills, and knowledge of medical terminology.

Qualifications

• 2-3 years of COB/third-party liability or healthcare experience required.
• Knowledge of medical terminology is essential.
• Strong customer service and communication skills are required.
• Ability to maintain HIPAA-compliant remote workspace.

Responsabilités

• Identify recovery opportunities within the COB department.
• Review, research, and process COB claims for members with other insurance.
• Reprocess COB-termed claims and ensure accurate updates in QNXT.
• Respond to internal email inquiries about claims/eligibility updates.
• Review MSP cases per Medicare guidelines and communicate status to the team.
• Coordinate recoveries with other insurers per federal regulations.

Connaissances

Customer service

Medical terminology

Communication

Organization

Problem-solving

Formation

High School Diploma or Equivalent

Outils

QNXT

Description du poste

Site: Mass General Brigham Health Plan Holding Company, Inc.Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.Job SummaryMass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.The role is responsible for investigating potential recoveries for Coordinaton of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordinaton of Benefits.Essential Functions-Responsible for identifying recovery opportunities within the Department.-Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.-Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.-Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding members' claims and/or eligibility updates.-Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.-Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.-Process Credit Balance claims, refund checks, and validate claims retractions.-Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates.QualificationsEducationHigh School Diploma or Equivalent requiredExperienceAt least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience requiredKnowledge, Skills, and AbilitiesStrong customer service skills.Knowledge of medical terminology.Excellent communication skills.High organization skills.Great problem-solving skills.Additional Job Details (if applicable)Working Conditions:This is a remote role that can be done from most US statesThe schedule for this position is Monday through Friday, 8:30 AM to 5:00 PM ESTRemote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employeesRemote TypeRemoteWork Location399 Revolution DriveScheduled Weekly Hours40Employee TypeRegularWork ShiftDay (United States of America)Pay Range$22.22 - $31.71/HourlyGrade4At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.EEO Statement:8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.