AlbanyNYRecruiter Since 2001
the smart solution for Albany jobs

Associate, COB & Recovery

Company: MVP Health Care
Location: Albany
Posted on: October 13, 2021

Job Description:

Associate, COB & Recovery
Headquarters Office, 625 State Street, Schenectady, New York, United States of America

  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America Req #899

    Thursday, September 9, 2021

    Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!

    Status: Full-time, Non-Exempt

    Summary:

    Investigate, monitor and review other group health coverage that may be primary over MVP plans through various reports and online methods including inbound/outbound calls. Updating and documenting all COB information into member's records with information obtained from the investigations and research including other insurance effective/terminated dates, type of coverage, accident dates, diagnosis for related injury and any other information pertinent to the claim and/or case. Applies COB rules and regulations following CMS and NAIC guidelines as well as departmental processes and procedures. Review of claims history for possible claim adjustments requests. Research and respond to all incoming inquiries via claim submissions, correspondence, internal service forms or calls. Working knowledge of Worker's Compensation, No Fault, Third Party Liability, Other Insurance and Medicare as it relates to coordination of benefits in determining primacy, application of Explanation of Benefits in secondary benefits claim review, handling and processing of checks, vendor recoveries and calls. Perform collections efforts of all outstanding system negative balances in order to meet and maintain defined departmental goals and standards. Process all returned MVP checks and provider/member refund checks including posting to the claims accounting system. Process and apply all recoveries from various outside recovery/ subrogation vendors including posting to the claims accounting system. Using established procedures, review, monitor and/or investigate aged negative balances through system reports for outreach to providers/facilities and members for collections. Prepare and submit all uncollectable negative balances for collections to outside collections agency. Responsible for the contacting through outbound calls/correspondence to providers/facilities to establish and develop working professional relationships in order to resolve and apply refund balances. Responsible for the adjusting, reprocessing and posting of all refund and or returned checks in the claims system. Responsible for compiling appropriate back up for any and all transactions required to complete the posting and/or admin check requests. (i.e. canceled checks, remittances and copies of claims as needed to support recovery and posting efforts). Handle inquiries from providers/facilities in applying system recoveries as well as resolve inquires and education of the account reconciliation of patients accounts. Resolve COB & Recovery incoming/outgoing calls from internal and external customers by providing professional and knowledgeable customer service to all and meeting departmental standards. Must be able to work additional hours as necessary.

    Minimum Education:

    AAS in Business or Finance or two years experience in insurance or related field preferred.

    Minimum Experience:

    Medical claims processing experience required. Familiarity with CPT-4 and ICD-10 procedural and diagnosis coding and medical terminology.
    Must be experienced or knowledgeable in one or more of the following areas: No Fault, Workers' Compensation, Third Party Liability, Medicare and/or other Insurance. Prior experience with Accounts Payable or Finance preferred. Prior COB experience including familiarity with reading various EOB forms highly desirable. Coordination

    of Benefits experience/knowledge of NYS and Federal regulations pertaining to the order of benefits preferred.

    Required Skills:

    Must have excellent computer skills and proficient in Excel/spreadsheets;

    Excellent math and organizational skills;

    Must have outstanding communication skills both written/verbal, interpersonal skills and strong customer service orientation;

    Strong problem solving skills with attention to detail

    Must maintain HIPAA compliance.

    Facets system knowledge a plus.

    About MVP
    MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com

    Please apply and learn more - including how you may become a proud member of our team.

    Other details
  • Job Family Claims/Operations
  • Pay Type Hourly

Apply Now

initStaticMap(); {"@context":"https://schema.org/","@type":"JobPosting","title":"Associate, COB & Recovery","datePosted":"2021-09-09T00:00:00","validThrough":null,"description":"Status: Full-time, Non-ExemptSummary:Investigate,\r\nmonitor and review other group health coverage that may be primary over MVP\r\nplans through various reports and online methods including inbound/outbound\r\ncalls. Updating and documenting all COB information into member's records with\r\ninformation obtained from the investigations and research including other\r\ninsurance effective/terminated dates, type of coverage, accident dates,\r\ndiagnosis for related injury and any other information pertinent to the claim\r\nand/or case. Applies COB rules and regulations following CMS and NAIC\r\nguidelines as well as departmental processes and procedures. Review of\r\nclaims history for possible claim adjustments requests. Research and\r\nrespond to all incoming inquiries via claim submissions, correspondence,\r\ninternal service forms or calls. Working knowledge of Worker's\r\nCompensation, No Fault, Third Party Liability, Other Insurance and Medicare as\r\nit relates to coordination of benefits in determining primacy, application of\r\nExplanation of Benefits in secondary benefits claim review, handling and\r\nprocessing of checks, vendor recoveries and calls. Perform collections\r\nefforts of all outstanding system negative balances in order to meet and\r\nmaintain defined departmental goals and standards. Process all returned MVP\r\nchecks and provider/member refund checks including posting to the claims\r\naccounting system. Process and apply all recoveries from various outside\r\nrecovery/ subrogation vendors including posting to the claims accounting\r\nsystem. Using established procedures, review, monitor and/or investigate aged\r\nnegative balances through system reports for outreach to providers/facilities\r\nand members for collections. Prepare and submit all uncollectable negative\r\nbalances for collections to outside collections agency. Responsible for the\r\ncontacting through outbound calls/correspondence to providers/facilities to\r\nestablish and develop working professional relationships in order to resolve\r\nand apply refund balances. Responsible for the adjusting, reprocessing\r\nand posting of all refund and or returned checks in the claims system. Responsible\r\nfor compiling appropriate back up for any and all transactions required to\r\ncomplete the posting and/or admin check requests. (i.e. canceled checks,\r\nremittances and copies of claims as needed to support recovery and posting\r\nefforts). Handle inquiries from providers/facilities in applying system\r\nrecoveries as well as resolve inquires and education of the account\r\nreconciliation of patients accounts. Resolve COB & Recovery\r\nincoming/outgoing calls from internal and external customers by providing\r\nprofessional and knowledgeable customer service to all and meeting departmental\r\nstandards. Must be able to work additional hours as necessary.Minimum\r\nEducation:AAS in Business or Finance or two years experience in insurance or related field\r\npreferred.Minimum\r\nExperience:Medical claims processing experience required. Familiarity\r\nwith CPT-4 and ICD-10 procedural and diagnosis coding and medical terminology.Must be experienced or knowledgeable in one or\r\nmore of the following areas: No Fault, Workers' Compensation, Third Party\r\nLiability, Medicare and/or other Insurance. Prior experience with\r\nAccounts Payable or Finance preferred. Prior COB experience including\r\nfamiliarity with reading various EOB forms highly desirable. Coordinationof Benefits experience/knowledge of NYS and Federal regulations pertaining to\r\nthe order of benefits preferred.Required\r\nSkills:Must\r\nhave excellent computer skills and proficient in Excel/spreadsheets;Excellent\r\nmath and organizational skills;Must\r\nhave outstanding communication skills both written/verbal, interpersonal skills\r\nand strong customer service orientation;Strong\r\nproblem solving skills with attention to detailMust\r\nmaintain HIPAA compliance.Facets\r\nsystem knowledge a plus.","employmentType":"FULL_TIME","hiringOrganization":{"@type":"Organization","name":"MVP Health Care","logo":"https://us61p.dayforcehcm.com/CandidatePortal/en-US/mvphealthcare/Go?item=d49ce0ce-e622-4e29-ad2b-621b5daca722"},"jobLocation":[{"@type":"Place","address":{"@type":"PostalAddress","streetAddress":"220 Alexander Street","addressLocality":"Rochester","addressRegion":"New York","postalCode":"14607","addressCountry":"USA"}},{"@type":"Place","address":{"@type":"PostalAddress","streetAddress":"625 State Street","addressLocality":"Schenectady","addressRegion":"New York","postalCode":"12305","addressCountry":"USA"}}],"jobLocationType":null,"baseSalary":{"@type":"MonetaryAmount","value":{"@type":"QuantitativeValue","value":null,"minValue":null,"maxValue":null,"unitText":"HOUR"}}}

  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America
  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America

Keywords: MVP Health Care, Albany , Associate, COB & Recovery, Other , Albany, New York

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest New York jobs by following @recnetNY on Twitter!

Albany RSS job feeds