The Coordination of Benefits (COB) Coordinator I shall be responsible for all duties listed under the COB Assistant position, in addition to serving as the primary contact for incoming COB related phone calls. The COB Coordinator I will also be responsible for claims adjudication and adjustments. The COB Coordinator I shall determine Independent Health’s obligation for claim payment as it relates to New York State Rules & Regulations, NAIC Guidelines, IH policies, summary plan descriptions, member contract, and Centers for Medicare and Medicaid Services (CMS) guidelines for all lines of business. The COB Coordinator I will be responsible to work independently and maintain an acceptable level of production with minimal supervision and demonstrate moderate problem-solving and decision-making skills. The COB Coordinator I is responsible for carrying out the necessary investigation of other insurance, including a member’s working status, diagnosis of potential workers’ compensation, motor vehicle accidents, and the pursuit of liens and liabilities. This position will also be responsible for achieving departmental savings targets associated with coordination of benefits, which contributes to the overall organizational savings plan and medical loss ratio.
Associates degree w/ (1) year experience in a health care environment or High school diploma/GED w/two years experience in health care operations environment may be accepted in lieu of degree requirement.
Minimum of one year with two years’ experience preferred in health insurance operations.
Experience with secondary payer process and procedures preferred.
Two years experience with claims processing required.
Experience applying COB against NYS Rules and Regulations, NAIC Guidelines and CMS Guidelines preferred
Solid verbal, written and interpersonal communication skills, with proven customer service skills. Customers can include, but is not limited to; a member, provider, attorney, employer group or another insurance company.
Proficiency with data entry skills and Microsoft Office (Word, Excel) products required.
Demonstrated experience with independent decision making to include effective problem resolution.
Assume responsibility and adhere to departmental deadlines and turn around times, in order to be compliant with State and Federal regulations.
Strong organizational skills with attention to detail and follow through.
Ability to work collaboratively within and outside of the Department.
Flexibility to work additional hours as needed.
May be required to represent Independent Health in legal settings
Ability to meet all department goals to include accuracy, productivity and savings goals.
Proven examples of displaying the IH values: Passion, Caring, Collaborative, Respectful and Accountable.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.
Independent Health is an equal opportunity employer.