Provider Maintenance & COB Coordinator at UNITE HERE HEALTH – Oak Brook, Illinois
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About This Position
UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!
The Provider Maintenance and COB Coordinator role is to examine claims data, review and update provider records, including documents needed from providers to ensure accurate claims processing. Determines primacy rules as related to Coordination of Benefits (COB) policy provisions and updates member records accordingly. This position utilizes multiple systems in order to perform the day-to-day functions of maintaining provider records, updating of COB primacy for our members, as well as, provider and member driven inquiries.
ESSENTIAL JOB FUNCTIONS AND DUTIES
- Determines the need for additional information from providers and other insurance carriers to ensure the Fund has complete and accurate records
- Effectively search online resources to verify provider information including, but not limited to address verification, provider specialty and National Provider ID (NPI) numbers
- Updates and maintains internal Taxonomy Crosswalk database on an as needed basis
- Creates and updates provider records within the claims processing system, including W9 forms and related claim denial reports
- Professional phone etiquette when contacting providers to request W9 forms or validate provider information
- Responsible for working various inventory work items related to provider records and COB updates
- Responsible for provider year end activities including CP2100 report and B-notices
- Updates COB information within the claims processing system to ensure accuracy of claim payments
- Works with internal and external resources to make sure the Fund has the most recent and accurate COB information
- Participates in projects related to recurring COB updates, testing and reporting
- Responds to all provider and COB related inquiries professionally and timely within established metrics
- Responsible for monthly ESRD reports including working closely with the Medical Directorate team
- Identifies and reports on trends related to provider or COB functions to mitigate adverse member impact
- Meets or exceeds established productivity and quality expectations
- Sets goals and achieve measurable results
- Contributes ideas to plans and achieving department goals
- Exemplifies the Fund’s BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
- Performs other duties as assigned within the scope of responsibilities and requirements of the job
- Performs Essential Job Functions and Duties with or without reasonable accommodation
ESSENTIAL QUALIFICATIONS
Years of Experience and Knowledge
- 2 ~ 3 years of related experience in a medical claim adjudication environment, or 2 years in health care or insurance environment
- Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
- Experience with eligibility verification, medical coding, coordination of benefits and subrogation
- Experience with medical terminology, International Classification of Diseases (ICD)10 and Current Procedures Terminology (CPT) codes
Education, Licenses, and Certifications
- High School Diploma or GED
- College degree preferred
Skills and Abilities
- Intermediate level Microsoft Office skills (, Word, Outlook)
- Intermediate level Microsoft Excel skills
- Intermediate level system(s) skills in Javelina claims system or similar system preferred
- Communication skills, (verbal and written)
- Problem solving, multi-tasking and decision-making skills
- Customer service
OTHER JOB FUNCTIONS AND DUTIES
The information contained in this job description is designed to indicate the general nature and level of work performed in this job with a certain degree of specificity, where warranted. In no instance, however, should the duties, functions, qualifications, or requirements be interpreted as all-inclusive. Management may, at its discretion, assign or reassign functions and duties to or from this job at any time, due to reasonable accommodation or other reasons. Listed requirements, skills, qualifications and abilities included have been determined to illustrate the minimal standards required to successfully perform the position.
Salary range for this position: Hourly rate: $18.8718 - $23.1282. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
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