Job Description
- 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
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