Associate, COB & Recovery #899
Status: Full-time, Non-Exempt
Investigate, monitor and review other group health coverage that may be primary over MVP plans through various reports and online methods including inbound/outbound calls. Updating and documenting all COB information into member’s records with information obtained from the investigations and research including other insurance effective/terminated dates, type of coverage, accident dates, diagnosis for related injury and any other information pertinent to the claim and/or case. Applies COB rules and regulations following CMS and NAIC guidelines as well as departmental processes and procedures. Review of claims history for possible claim adjustments requests. Research and respond to all incoming inquiries via claim submissions, correspondence, internal service forms or calls. Working knowledge of Worker’s Compensation, No Fault, Third Party Liability, Other Insurance and Medicare as it relates to coordination of benefits in determining primacy, application of Explanation of Benefits in secondary benefits claim review, handling and processing of checks, vendor recoveries and calls. Perform collections efforts of all outstanding system negative balances in order to meet and maintain defined departmental goals and standards. Process all returned MVP checks and provider/member refund checks including posting to the claims accounting system. Process and apply all recoveries from various outside recovery/ subrogation vendors including posting to the claims accounting system. Using established procedures, review, monitor and/or investigate aged negative balances through system reports for outreach to providers/facilities and members for collections. Prepare and submit all uncollectable negative balances for collections to outside collections agency. Responsible for the contacting through outbound calls/correspondence to providers/facilities to establish and develop working professional relationships in order to resolve and apply refund balances. Responsible for the adjusting, reprocessing and posting of all refund and or returned checks in the claims system. Responsible for compiling appropriate back up for any and all transactions required to complete the posting and/or admin check requests. (i.e. canceled checks, remittances and copies of claims as needed to support recovery and posting efforts). Handle inquiries from providers/facilities in applying system recoveries as well as resolve inquires and education of the account reconciliation of patients accounts. Resolve COB & Recovery incoming/outgoing calls from internal and external customers by providing professional and knowledgeable customer service to all and meeting departmental standards. Must be able to work additional hours as necessary.
AAS in Business or Finance or two years experience in insurance or related field preferred.
Medical claims processing experience required. Familiarity with CPT-4 and ICD-10 procedural and diagnosis coding and medical terminology.
Must be experienced or knowledgeable in one or more of the following areas: No Fault, Workers’ Compensation, Third Party Liability, Medicare and/or other Insurance. Prior experience with Accounts Payable or Finance preferred. Prior COB experience including familiarity with reading various EOB forms highly desirable. Coordination
of Benefits experience/knowledge of NYS and Federal regulations pertaining to the order of benefits preferred.
- Must have excellent computer skills and proficient in Excel/spreadsheets;
- Excellent math and organizational skills;
- Must have outstanding communication skills both written/verbal, interpersonal skills and strong customer service orientation;
- Strong problem solving skills with attention to detail
- Must maintain HIPAA compliance.
- Facets system knowledge a plus.
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at firstname.lastname@example.org
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