The COB/TPL Administrative Coordinator role will be centered around sorting, mailing, distributing and monitoring of department correspondence, along with data entry and member eligibility verifications. The candidate will be responsible for either TPL or COB duties as follows. This is a high energy position which requires a strong sense of urgency and prioritization.
TPL Coordinator Duties:
Responsible for printing and mailing all COB and TPL correspondence, including certified mail. Approx 100-150 mail items per day.
Responsible for updating new/current TPL files in Image Silo for NEDocs.
Responsible for receiving, scanning and tracking all TPL lien settlement checks and sending them to Finance each day.
Able to verify TPL 2k and 8k PIP letters for daily mail.
Maintain a consistent work flow of correspondence to ensure timely delivery of certified mail and time sensitive material.
Exceptional awareness of HIPAA regulations to ensure all member PHI is protected while handling high correspondence volume.
Fax/Scan priority claim call trackings to COB/TPL Reps working from home.
Monitor/order NHP letterhead, envelopes, certified cards for COB and TPL teams. Print certified cards for TPL Reps when needed.
Responsible for monitoring and maintaining the TPL printer and making arrangement for technical support to ensure consistent correspondence production.
Prepare and send closed TPL files to NEDocs monthly along with file lists for scanning. COB Coordinator Duties:
Responsible for understanding and accurately assisting with COB inquiries from internal departments, members, providers and other health plans.
Responsible for monitoring the monthly eligibility files from various vendors and ensuring all member eligibility is updated accurately and timely.
Responsible for daily verification using claim edit identification and assigned projects.
Responsible for quarterly CMS query file and Medicare eligibility updates.
Responsible for making phone inquiries to health plans, members, providers and CMS.
Responsible for understanding and applying COB claim attributes to ensure accurate reporting of COB savings each month.
Responsible for understanding all claim edits as they relate to COB claim processing and reporting.
Responsible for retrieiving voice mail messages and following proper department procedures to assist with issues.
Responsible for processing all COB questionnaire received from NHP's Self Funded and Performance Guarantee groups.
Works closely with COB team and assist with daily duties as assigned.
Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
Hold self and others accountable to meet commitments.
Ensure diversity, equity, and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization. Other duties as assigned with or without accommodation.
Work is normally performed in a typical office work environment. Required:
High School diploma or GED is required.
Strong organizational and time management skills a must.
Must be proficient in Microsoft Word, and Excel.
Proficient PC skills including familiarity with Microsoft Access.
Knowledge of Qnxt Claim Payment System
Knowledge of Coordination of Benefits/Third Party Liability
The successful candidate will possess strong organizational and time management skills.
Customer service skills, excellent communication skills, and be able to multi-task and prioritize. In addition, you must have problem solving skills and be highly organized.
Demonstrates NHP Core Values of Service Excellence, Quality Care, Diversity, Responsibility and Relationships.
Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner.
Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
Accountable for delivering high quality work.
Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
Be accountable for delivering high-quality work. Act with a clear sense of ownership.
Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
Certification or Conditions of Employment: