REPORTS TO: Technical Services Admin Team Leader
LOCATION: Allegiance office or off-site
FLSA STATUS: Non-Exempt
POSITION RESPONSIBILITIES:
The Coordination of Benefits Specialist will make determinations on primary and secondary coverages based on the coordination of benefits (COB) language contained in the plan. The incumbent will obtain missing claims information, update, and maintain the coordination accurately and report findings as needed to the Team Leader, enrollment, or pharmacy departments.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
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Researches COB information in the current period (within the prior 12 months), investigates primary/secondary determination and maintains COB records in LuminX. Evaluates each COB response for any changes of information. If changes are found, the information is maintained and documented in LuminX.
- Researches other coverage thoroughly using all resources available.
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Reviews annual letters and documents in LuminX.
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Reviews other mailboxes as assigned.
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Complies with all privacy and confidentiality laws in the course of business.
- Contributes to the daily workflow with regular and punctual attendance.
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Provides assistance with provider maintenance, faxing, and other additional duties as needed.
- Reviews and updates weekly reports to determine Medicare eligibility.
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Reviews additional reports as needed for accuracy and performs audits.
NON-ESSENTIAL JOB FUNCTIONS:
Performs related or other assigned duties as required or directed.
SUPERVISION EXERCISED:
None.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting 90% Reaching Some
Standing 5% Manual Dexterity High
Walking 5% Telephone Yes
Kneeling Some Computer Screen High (visual acuity corrected to 20/30)
Bending Some Lifting up to 20 lbs.
JOB SPECIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education: High school graduation or GED required. Training in medical terminology or equivalent knowledge through experience in a related field required.
Certification(s) Required: None.
Minimum Experience: Experience with computers required. Familiarity with group health benefits preferred.
Other Qualifications:
- Excellent oral and written communication skills required.
- PC skills, including Windows, Word and Access. Must be able to adapt to software changes as they occur.
- Typing ability of 40 wpm net.
- Knowledge of medical terminology and basic health insurance concepts.
- High level of interpersonal skills to work effectively with others.
- Ability to organize and respond to multiple demands in short periods of time.
- Ability to research and obtain data elements related to claims and COB information.
- Ability to project a professional image and positive attitude in any work environment.
- Ability to comply with confidentiality and privacy standards.
- Ability to be flexible, work under pressure and meet deadlines.
- Ability to analyze and solve problems with professionalism and patience.
- Ability to deal with occupational stress in a positive, professional manner.
- Ability to operate typical office equipment.
- Working knowledge of general office procedures
- Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: recruiting@askallegiance.com for support.