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Patient Financial Services COB Specialist

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Washington, DC
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Washington, DC
We the people of **MEMBERS ONLY**SIGN UP NOW***. believe in the endless pursuit of excellence, and in health and well-being for all. At **MEMBERS ONLY**SIGN UP NOW***. Mid-Atlantic States, weve built our culture on communication, teamwork, and respect. From our financial professionals and IT teammates to our RNs and physicians on the front line of care—we collaborate together to support each others goals and promote a balance between work and life. And we do it all in a dynamic landscape. From the excitement of our nations capital to the scenic coastlines of Maryland and Virginia, the Mid-Atlantic area offers plenty of year-round activity, making it the perfect place for you and your family to call home. Join us.
Identifies, researches & validates cases involving Medicare, Other Commercial Carrier, Dual Coverage & other 3rd Party Liability situations, including researching primacy determination on complex cases involving another payor, claims cost avoidance.
Key functions:
• Distributes eligibility surveys to appropriate members for the entire membership database.
• Places primary calls to members for the entire membership database when surveys aren't returned.
• Applies National Association of Insurance Commission(NAIC) guidelines to determine primary/secondary liabilities when required.
• Applies Medicare Secondary Payor & NAIC rules & regulations to determine Medicare & Commercial Primacy determination for accurate payment of benefits relative to Claims adjudication & billing.
• Generates & analyzes applicable departmental reports, documents revenue recovery opportunities from providers, attorneys & other insurance adjusters, etc. & communicates to Claims Administration.
• Reviews & responds to various forms of inquiries from CMS, providers, members, attorneys & other insurance personnel.
• Manages Macess workflow queues according to Claims department policies, guidelines & turn around time.
• Assists in the development & implementation of policies & procedures for the department & COB unit. Recommend changes to management.
• Interprets new laws & regulations in all operating jurisdictions including CMS, NAIC & federal & state. Communicates changes in regulations appropriately to all interested parties. Advise management of pending changes.
• Maintains working expertise of:
• Covered & non-covered Medicare benefits administration & Health Plan benefits.
• Specific provider contractual arrangements.
• Provider Service Center processes & procedures.
• Appeals process.
• Changes in Claims processing policies & procedures.
• Acts in the capacity of Medicare & Commercial COB subject matter specialist to several internal departments & external customers/clients.
• Provides linkages between the departments to facilitate recovery, billing & other primacy related issues.
• Maintains monthly reports on liens, 3rd Party & Workers Compensation questionnaires, recoupment revenue, adjustments & other related activities.
• Performs retroactive claims payment audit for newly identified Medicare & Commercial primary members. Communicates recovery opportunities to Claims Administration.
• Maintains Medicare & Commercial primacy determinations in TPL module, HSD Diamond & PFS Billing system.
• Performs other duties as directed.
Required requirements:
• 4yrs of background specializing in COB, Medicare, Medicaid, Dual Coverage TPL &/or Workers Compensation claims.
• Demonstrated skill in health insurance claims processing & benefits environment. Working knowledge of Medicare, medical & other insurance terminology.
• Background w/ computer applications & other PC based skills.
• Bachelor's degree or the equivalent relevant years of relevant work background required.
• Demonstrated background in industry practices & regulations in the tri-state area pertaining to Medicare, Workers Compensation, Dual Coverage & Subrogation.
• Demonstrated outstanding communication abilities: writing, verbal & negotiating skills.
• Knowledge of Medicare & other insurance products.
• Demonstrated writing & reporting skills.
Preferred Requirements:
• 1yr in a customer service environment preferred.
• Background working w/ cross-functional teams preferred.
Primary Location: Maryland-Rockville-Regional Office 2101 E. Jefferson St.
Scheduled Hours (1-40): 40
Shift: Day
Working Days: Mon-Fri
Working Hours Start: 8:00am
Working Hours End: 4:30pm
Schedule: Full time
Position category: Standard
Employee Status: Regular
Employee Group: Salaried Employees
Job Level: Individual Contributor
Job: Support Services
Public Department Name: Patient Financial Services
Travel: No
4 Year Degree
May 25
on Washington Post
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Company info

Kaiser Permanente
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Company Profile
Dr. Garfield's system of care integrated four core principles: group medical practice, prepayment of services, a focus on prevention, and a cornucopia of services under one roof. When he and industrialist Henry J. Kaiser joined forces in 1938, a partnership was born that set the course for the future.