This is contract opportunity.
Discovery Health Partners offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience. We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results.
We are looking for a contractor to work as a COB Recovery Specialist, who will be responsible for securing and evaluating health insurance and employment information to determine the correct order of claim payments for our clients. In addition, the Specialist identifies claim overpayments, conducts outreach to providers to secure recovery of incorrectly paid claims, and accurately documents findings and refunds for client billing and reporting.
RESPONSIBILITIES & JOB FUNCTIONS:
- Selecting from a list of predetermined cases, gather all related health insurance information and determine order of benefits based on guidelines and policy and procedures
- Analyze claims based on DOS, covered benefits and other related information to select claims with potential for refund/recovery
- Contact providers to inform them of claim overpayment, carrier re-bill information, and refund procedures according to client-specific requirements and in compliance with state and federal laws
- Prioritize casework based on aging, timely filing rules and recovery potential. Conduct follow-up with providers over the phone or in writing as needed to secure refunds for clients.
- Document all contacts through recovery or exhaustion of recovery effort.
- Respond to and resolve any client issues related to COB findings
- Complying with HIPAA regulations, as well as Security, Policies, and Procedures
Required Skills
- Persistent but respectful; able to influence others to perform rebills and send refunds
- The ability to ask questions to uncover the information needed
- Working knowledge of computers/scanners/MS Office products
Required Experience
- Must have minimum of high school education.
- 3+ years of experience in claim processing, eligibility/benefits, or coordination of benefits function for a doctor, hospital or insurance carrier
- Willingness to stay current with changes to the COB rules and regulations and perform continuous learning to produce strong results
Discovery Health Partners provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.