受益协调处理员（管理护理）- 远程
Coordination of Benefits Processor (Managed Care) Remote
Molina Healthcare 正在招聘协调福利处理人员。该职位为远程办公，可在多种地点工作。优先考虑太平洋时区的候选人。
该职位将为直接影响医疗费用和保费报销的福利协调审查活动提供支持。主要负责与其他负责付款的承保人协调福利。提供行政支持、数据录入以及其它保险记录的准确维护。
高度合格的候选人应具备以下经验：
- 医疗保健经验
- 行政医疗经验
- 熟练使用 MS Office 套件
- 高度关注细节
- 稳定的工作经历
核心工作职责
- 支持多个业务线（LOBs），包括医保（Medicare）和市场（Marketplace，MKP）
- 通过供应商门户、外拨电话和对费用解释（EOBs）的审查，验证外部医疗和药品覆盖情况，以识别和核实其他保险信息。
- 通过保险公司联络和在线资源，研究并验证州、供应商和内部的福利协调（COB）线索。
- 审核和解读 EOBs、医疗索赔和资格信息，以确定适当的 COB 操作。
- 处理供应商争议，并根据已验证的 COB 信息提交索赔调整，确保索赔正确支付。
- 维护内部数据库和其他保险记录，以确保准确的成员覆盖信息。
- 向 CMS 提交 ECRS 请求，以在 CMS 系统中更新外部覆盖信息。
- 遵守与 COB 和医保协调相关的部门程序、文档标准和监管要求。
- 为福利协调（COB）团队提供电话、行政和数据录入支持。
- 拨打电话或使用其他保险公司的门户，验证州、供应商和内部的 COB 线索。
- 更新索赔交易系统和 COB 跟踪数据库中的其他保险表。
- 直接联系医疗保险和医疗补助服务中心（CMS），或与指定的公司联系人协调，为医保次级付费者（MSP）和终末期肾病（ESRD）等项目登记票务以恢复保费。
职位要求
- 至少一年的行政支持经验，或相关教育和经验的同等组合。
- 客户服务技能
查看英文原文
Molina Healthcare is hiring for Coordination of Benefits Processor. This role is remote and can be worked from a variety of locations. PST Time Zone is preferred.
This role will provide support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records.
Highly Qualified Candidates Will Have the Following Experience-
- Healthcare Experience
- Administrative healthcare experience
- Solid experience with the MS Office Suite
- High attention to detail
- Solid work history
Essential Job Duties
- Supports multiple Lines of Business (LOBs), including Medicare and Marketplace (MKP)
- Validates external medical and pharmacy coverage through provider portals, outbound calls, and review of Explanation of Benefits (EOBs) to identify and verify other insurance information.
- Researches and validates state, vendor, and internal Coordination of Benefits (COB) leads through insurance carrier outreach and online resources.
- Reviews and interprets EOBs, medical claims, and eligibility information to determine appropriate COB actions.
- Processes provider disputes and submits claim adjustments to ensure claims are paid correctly based on validated COB information.
- Maintains Internal databases and other insurance records to ensure accurate member coverage information.
- Submits ECRS requests to CMS to update external coverage information within the CMS system.
- Maintains compliance with departmental procedures, documentation standards, and regulatory requirements related to COB and Medicare coordination.
- Provides telephone, administrative and data entry support for the coordination of benefits (COB) team.
- Phones or utilizes other insurance company portals to validate state, vendor and internal COB leads.
- Updates the other insurance table on the claims transactional system and COB tracking database.
- Contacts Centers for Medicare and Medicaid Services (CMS) directly, or coordinates with the assigned company contact to log tickets for premium restoration such as Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD). Job Requirements
- At least 1 year of administrative support experience, or equivalent combination of relevant education and experience.
- Customer service skills.
- Attention to detail, organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
- Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications• Health care experience.
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Same Posting Description for Internal and External Candidates
Originally posted on Himalayas