Coordination of Benefits (COB) Coordinator

Doctors HealthCare Plans, Inc.; Coral Gables (FL); On-site; USD 55,000 - 70,000; Full time

Job summary

Doctors HealthCare Plans, Inc. is seeking a COB Coordinator to coordinate benefits between the company and other insurance carriers.

You will analyze and adjudicate claims that involve other insurers, process COB claims per CMS guidelines, and communicate with providers and members to resolve complex cases. The role requires 1–3 years of health claims processing experience, working knowledge of COB/MSP, and strong organizational and bilingual English/Spanish skills.

Qualifications

• 1–3 years of Health claims processing experience.
• Working knowledge of COB and MSP.
• Working knowledge of medical terminology.

Responsibilities

• Analyze, process, research and adjudicate claims that involve other insurance carriers.
• Process and monitor COB claims according to CMS guidelines.
• Investigates members for other insurance through phone calls and correspondence.
• Responsible for send and monitor questionnaires / letter sent to members and providers.
• Responsible for timely processing of COB claims.
• Maintains quality standards in all research and adjustment functions.
• Enter claims or verify data entry for accuracy and completeness.
• Uses online policies and procedures to ensure accuracy in claims processing.
• Acts in liaison to providers and members for special claims handling.
• Contributes to team effort by accomplishing related results as needed.
• Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
• Promotes and contributes to a positive, problem-solving environment.
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
• Ensures compliance with HIPAA, OSHA, and other regulations.
• Participates in meetings, training and in-service education, as required.
• Performs other duties as assigned.

Skills

Communication

Claims processing

Organization

Bilingual: English/Spanish

COB knowledge

Medical terminology

Job description

The Main function of a Coordination of Benefits (COB) Coordinator is to coordinate benefits between Doctors Healthcare Plans, Inc. and other insurance carriers that may be liable for the services provided to our members.

Responsibilities

• Analyze, process, research and adjudicate claims that involve other insurance carriers.
• Process and monitor COB claims according to CMS guidelines.
• Investigates members for other insurance through phone calls and correspondence but not limited to claim adjustment requests or appeals.
• Responsible for send and monitor questionnaires / letter sent to members and providers.
• Responsible for timely processing of COB claims.
• Maintains quality standards in all research and adjustment functions.
• Enter claims or verify data entry for accuracy and completeness.
• Uses online policies and procedures to ensure accuracy in claims processing.
• Acts in liaison to providers and members for special claims handling.
• Contributes to team effort by accomplishing related results as needed.
• Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
• Promotes and contributes to a positive, problem-solving environment.
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
• Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
• Participates in meetings, training and in-service education, as required.
• Performs other duties as assigned.

Qualifications

• Excellent oral and written communication skills
• 1 – 3 years of Health claims processing experience
• Working knowledge of COB and MSP preferably
• Working knowledge of medical terminology
• Working knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
• Excellent organizational skills
• Ability to work well under pressure indifficult situations
• Bilingual: English / Spanish (Required)

Note: This description indicates, in general terms, the type and level of work performed andresponsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.