Coordination of Benefits Processor (Managed Care)
New
M
Molina HealthcareHealthcare insurance
Source API remote eligibility restrictions: United States, PST Time Zone is preferred.Full-TimeJunior
Salary not disclosed
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Job Details
- Experience
- At least 1 year of administrative support experience, or equivalent combination of relevant education and experience.
- Required Skills
- Microsoft OfficeCustomer serviceTime ManagementData entry
Requirements
- Have at least 1 year of administrative support experience, or an equivalent combination of relevant education and experience.
- Bring customer service skills.
- Demonstrate attention to detail, organizational skills, and time-management skills.
- Be able to manage simultaneous projects and tasks to meet internal deadlines.
- Work collaboratively across a highly matrixed organization.
- Establish and maintain effective relationships with internal and external stakeholders.
- Demonstrate effective verbal and written communication skills.
- Be proficient with the Microsoft Office suite and applicable software programs.
- Healthcare experience is preferred.
Responsibilities
- Support multiple lines of business, including Medicare and Marketplace.
- Validate external medical and pharmacy coverage through provider portals, outbound calls, and Explanation of Benefits (EOBs).
- Research and validate state, vendor, and internal Coordination of Benefits (COB) leads using carrier outreach and online resources.
- Review and interpret EOBs, medical claims, and eligibility information to determine appropriate COB actions.
- Process provider disputes and submit claim adjustments based on validated COB information.
- Maintain internal databases, other insurance records, the claims transactional system, and the COB tracking database.
- Submit ECRS requests to CMS to update external coverage information.
- Maintain compliance with departmental procedures, documentation standards, and regulatory requirements related to COB and Medicare coordination.
- Provide telephone, administrative, and data-entry support to the COB team.
- Coordinate with CMS or assigned company contacts to log tickets for premium restoration, including Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD).
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