coordination of benefits verification rep

About the position The Coordination of Benefits Verification Representative position is a critical role responsible for investigating potential recoveries for Coordination of Benefits (COB) by leading the verification of other insurances through various communication methods, including phone calls and other systems as required. This role requires a high level of customer service, as the representative will manage communications with both internal and external customers, ensuring that all inquiries are handled efficiently and effectively. The representative will interact directly with other insurance companies, healthcare providers, members, and the Centers for Medicare & Medicaid Services (CMS) to gather and provide necessary information regarding benefits coordination. In this position, the representative will be tasked with identifying recovery opportunities within the COB/Third Party Liability (TPL) Department. This includes reviewing and validating other insurance information by contacting various health plans, both state and national. The representative will also be responsible for documenting and communicating this information to internal customers on the COB team. Additionally, the role involves handling phone calls to and from members, providers, and other insurance companies to collect or disseminate COB data, as well as addressing email inquiries from internal customers regarding member claims and eligibility updates. The representative will maintain and update accurate COB information in the QNXT system for reporting purposes to MassHealth and other stakeholders. They will also process COB questionnaires sent to members, monitor responses, and communicate findings to COB colleagues for follow-up. The role requires the representative to review projects or reports concerning members with other insurances, flagging those with relevant COB information. Meeting monthly quality assurance metrics established by the department is essential, as is the ability to anticipate and exceed customer expectations, thereby establishing and maintaining effective relationships with customers. Responsibilities • Identify recovery opportunities within the COB/TPL Department. , • Review and validate other insurance information by contacting other health plans (state and national). , • Communicate and document insurance information to internal customers on the COB team. , • Handle phone calls to or from members, providers, and other insurance companies to gather or provide COB data. , • Review, research, and resolve email inquiries from internal customers regarding member claims and eligibility updates. , • Maintain and update accurate COB information in QNXT for reporting to MassHealth and other customers as needed. , • Process COB questionnaires to members and monitor and document responses. , • Communicate findings to COB colleagues for follow-up. , • Review projects or reports of members with other insurances and flag members with COB information. , • Meet monthly quality assurance metrics established by the department. , • Anticipate and meet or exceed internal and/or external customer expectations and requirements. Requirements • High School diploma or GED is required. , • Associate's Degree or equivalent combination of training and experience is preferred. , • 2-4 years of related experience in the COB/TPL or other healthcare-related field. , • Knowledge in working with third-party payors. , • Proficient in Microsoft Word, Excel, and Access. , • Knowledge of ICD-9, CPT & HCPC coding or equivalent experience. Nice-to-haves • Experience in medical billing. , • Strong time management skills. , • Familiarity with health insurance policies. Benefits • Health insurance coverage. , • 401K contribution (based on eligibility). , • Incentive and recognition program. Apply Job!