COB Representative
COB Representative
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Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
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 Coordinaton 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 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
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$21.78 - $31.08/HourlyGrade
4EEO Statement:
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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
