COB Representative at Partner's Healthcare in Somerville, Massachusetts

Job Description:

Site: Mass General Brigham Health Plan Holding Company, Inc.


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
The role is responsible for investigating potential recoveries for Coordinaton of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordination of Benefits.


Essential Functions
-Responsible for identifying recovery opportunities within the Department.>

-Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.
-Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.
-Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding members' claims and/or eligibility updates.
-Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.
-Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
-Process Credit Balance claims, refund checks, and validate claims retractions.
-Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates.



Qualifications



Education

• High School Diploma or Equivalent required

Experience

• At least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience is required

Knowledge, Skills, and Abilities

• Strong customer service skills.


• Knowledge of medical terminology.


• Excellent communication skills


• High organization skills.


• Great problem-solving skills.

Additional Job Details (if applicable)



Working Conditions:

• This is a remote role that can be done from most US states


• This is a Monday - Friday role with standards business hours (in Eastern time)

Physical Requirements

• Standing Occasionally (3-33%)


• Walking Occasionally (3-33%)


• Sitting Constantly (67-100%)


• Lifting Occasionally (3-33%) 20lbs - 35lbs


• Carrying Occasionally (3-33%) 20lbs - 35lbs


• Pushing Rarely (Less than 2%)


• Pulling Rarely (Less than 2%)


• Climbing Rarely (Less than 2%)


• Balancing Occasionally (3-33%)


• Stooping Occasionally (3-33%)


• Kneeling Rarely (Less than 2%)


• Crouching Rarely (Less than 2%)


• Crawling Rarely (Less than 2%)


• Reaching Occasionally (3-33%)


• Gross Manipulation (Handling) Constantly (67-100%)


• Fine Manipulation (Fingering) Frequently (34-66%)


• Feeling Constantly (67-100%)


• Foot Use Rarely (Less than 2%)


• Vision - Far Constantly (67-100%)


• Vision - Near Constantly (67-100%)


• Talking Constantly (67-100%)


• Hearing Constantly (67-100%)

Remote Type


Remote



Work Location


399 Revolution Drive



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.




Mass General Brigham Competency Framework



At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now