Healthfirst

Position Summary: This Healthfirst Coordination of Benefits (COB) Specialist is responsible for investigating and, updating information on coordination of benefits for Healthfirst members. This may include initiating telephone calls to other insurance carriers to gather coordination of benefits information and determining primacy. In addition, this role may also be responsible for the appropriate claims adjudication of COB services, as well as the recovery of overpaid COB claims according to all applicable claims policies and procedures. This role will also ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance as well as monitoring daily work flow, maintaining production, performance and quality standards.

Duties & Responsibilities: 

• Identify members who have additional coverage and update company systems
• Initiate outbound calls to members and/or other primary insurers to validate insurance coverage, update all Healthfirst and/or secondary systems (including potentially CMS and State systems which track COB information), and determine primacy of said coverage.
• Initiate subsequent recovery efforts as a result of any validations completed, inclusive of either reprocessing the claims, or submitting the overpayment recovery project through the appropriate channels.
• Serve as a liaison to internal departments that initiate service forms regarding verification of other insurance coverage.
• Work closely with all external vendors who have been contracted to supply Healthfirst with COB related information, inclusive of monitoring file transfers, working the files and taking appropriate corresponding action in Healthfirst systems, and establishing/monitoring controls related to all files/members and claims worked.
• Work with data analysts to appropriately identify overpaid claims as a result of retroactive discovery of COB.
• Maintain daily work-flow and a standard of production with quality and accuracy.
• Respond to any regulatory or compliance requests for information or audits in a timely and accurate manner.
• Support management with reports, special projects, and other duties as assigned. 

Minimum Qualifications:   

• High School Diploma OR GED from an accredited institution.
• Work experience demonstrating oral and written communication skills.
• Health insurance claims processing, COB or related experience
• Experience speaking directly with providers and provider billing offices regarding claims issues
• Basic understanding and experience working with document imaging and workflow routing systems.
• Experience with PC applications and ability to toggle between multiple systems or applications entering date in multiple fields
• Experience with Microsoft Office suite of applications including Outlook and Excel with ability to create and use Excel reports to efficiently manage information by using features such as search/find, sort/filter, formatting/filtering, inserting columns/rows/field and creating additional worksheets/tabs.

Preferred Qualifications: 

• Basic understanding and experience of claim processing knowledge.
• Associates Degree from an accredited institution
• Ability to work under minimal supervision
• Communicate with skill, tact, persuasion and/or negotiation to accomplish the objectives of the communication.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960

• All Other Locations (within approved locations): $49,795 - $72,800

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.