Job Description:
• Review assigned pre-pay or post-pay records, investigate coverage, and determine primacy to maximize revenue for client’s recovery programs.
• Review eligibility and other documentation to verify current payer order of benefits.
• Leverage knowledge and expertise in COB/TPL to review eligibility.
• Identify trends from payer data to process appropriately per client and business needs.
• Contact Healthcare Insurance carriers regarding eligibility discrepancies.
• Educate Healthcare Insurance carriers on Coordination of Benefits rules.
• Analyze written communication from insurance companies including explanation of benefits (EOBs).
• Support internal groups with gathering and interpretation of eligibility work.
• Follow standards of quality and productivity metrics assigned by management.
Requirements:
• High School diploma or GED.
• Minimum 2 years of directly relevant progressive experience in Healthcare with a focus including but not limited to claims, billing, membership, enrollment, eligibility, customer service and/or call center demonstrating depth of knowledge and capability required for the position.
• 12 months direct experience in COB, TPL, Reclamation and/or Recovery is preferred.
Benefits:
• medical
• dental
• vision
• HSA/FSA options
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually