COB Analyst - Medicare

Medicare Advantage Health Plan Miramar, Florida


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Clear Spring Health

COB Analyst - Medicare

Location – Miramar, FL

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security.  Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary:

The Coordination of Benefits Analyst can be responsible for the timely and accurate coordination of member plan benefits, Third Party Liability (TPL) and Medicare Secondary Payor (MSP). The Analyst will gather information, answer questions and resolve primary issues through coordination of benefit when multiple forms of coverage are available for the plan member using the Medicare standards. Analyst will communicate effectively with other carriers to update and validate eligibility records in our system.

 

Main Accountabilities:

  • Communicating with other Health insurance regarding benefits and explaining coverage to maintain established levels for accuracy and productivity
  • Providing information regarding coverage status to providers and other internal departments
  • Researching and resolving billing issues identified by members or providers
  • Confirming member's current other health coverage (OHC) information, excluding Medicare, with each OHC referral source
  • Coordinating resolution of issues related to payments, coverage, and member data with other internal departments
  • Receiving proof of eligibility, verifying accuracy of information received, updating internal database, and sending information to CMS for closure of record
  • Acting as a liaison and promoting positive communication with members, providers, other commercial insurance companies, County staff, and other CMS representatives
  • Assisting with the development and implementation of policies and procedures, work instructions, and workflows related to COB
  • Identify and handle third party liability (TPL) or coordination of benefits (COB) issues
  • Coordinating and facilitating recoveries related to coordination of benefits
  • Identify and refer potential fraud and abuse cases to the Compliance Department
  • Conducting research and reviewing cases of members with OHC to identify cost recovery, potential high cost cases, and possible Health Insurance Premium Payment referral
  • Researching and identifying primary, secondary, and tertiary OHC status
  • Identify opportunities for COB / MSP process improvements
  • Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames 
  • Ability to read, write and communicate at a professional level
  • Effective time management and organizational skills
  • Effective interpersonal and communication skills
  • Other duties and responsibilities as may be assigned
  • Display actions that align with our Vision, Mission, and Values

 

Qualifications:

  • Associated degree preferred or equivalent experience
  • Knowledge of medical reimbursement policies, procedures and standards.
  • Knowledge of health care billing standards and procedures.
  • Computer proficiency in a Windows environment, knowledge of Microsoft Office products
  • Strong knowledge of medical terminology
  • Knowledge of data analysis methods.
  • Knowledge of CPT Codes, HCPCs and ICD-10 codes
  • Medicare experience preferred