Associate, COB & Recovery
Company: MVP Health Care
Location: Albany
Posted on: October 13, 2021
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Job Description:
Associate, COB & Recovery
Headquarters Office, 625 State Street, Schenectady, New York,
United States of America
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
Apply Now
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Keywords: MVP Health Care, Albany , Associate, COB & Recovery, Other , Albany, New York
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