TPL & Coordination of Benefits Analyst

LSU New Orleans; New Orleans (LA); On-site; USD 60,000 - 70,000; Full time

Job summary

The University of New Orleans is seeking a TPL Coordinator to respond to provider, health plan, and member inquiries, coordinating benefits between Medicaid and other primary insurance sources.

The role investigates billing issues, supports Medicare/TPL billing, helps develop policies, and ensures contract language is followed.

You will work with LDH, MCOs, and providers to monitor performance, prepare advisories, and keep TPL plans current.

Qualifications

• 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.

Responsibilities

• Coordinate benefits between Medicaid and other primary insurance sources.
• Investigate billing and payment issues including denied claims.
• Assist with Medicare/TPL billing and related policies.
• Develop and implement TPL policies and procedural changes.
• Create and maintain health plan advisories and informational bulletins.
• Monitor TPL administration and contract deliverables.
• Assist with RFPs and contract negotiations.
• Report TPL KPIs and quarterly financials.
• Communicate with providers, members, Medicaid staff, contractors, and third party insurers.

Skills

Analytical skills

Organizational skills

Communication skills

Time management

Education

Bachelor’s degree or 6 years’ experience in lieu of degree

Tools

CPT/ICD-10/HCPCS

Job description

Department

TPL Unit 1

Job Summary

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.
This includes proactively 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.

QUALIFICATIONS REQUIRED

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.

DESIRED

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.

SALARY

SALARY: 60-70k

Required Attachments

Please upload the following documents in the Resume/Cover Letter section.
Detailed resume listing relevant qualifications and experience; Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems; Names and contact information of three references; Applications that do not include the required uploaded documents may not be considered.

Posting Close Date

This position will remain open until filled.

Note to Applicant

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials. References will be contacted at the appropriate phase of the recruitment process. This position may require a criminal background check to be conducted on the candidate(s) selected for hire. As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

Equal Employment Opportunity

The University of New Orleans seeks to recruit a highly productive workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.