Where compassion meets innovation and technology and our employees are family.

• Analyze members with other insurance coverage to determine the correct order of benefits.

• Audit claims to identify services paid as primary in error.

• Analyze COB claims to determine correct claim payment.

• Research and validate other insurance coverage with insurance carriers.

• Support vendor oversight of COB recovery-related activities.

• Coach/mentor team members regarding opportunities for identification of COB.

• Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality.

• Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork.

• Maintain required compliance with privacy and confidentiality standards.

• Maintain or exceed all established standards for performance, quality, and timeliness.

• Support the Claims department in the review, investigation, and research of claims issues.

• Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.

• Assist with other related work responsibilities as requested.

EDUCATION AND/OR EXPERIENCE -

• Minimum three years professional experience in claims analysis, provider medical billing, or medical coding; experience with Texas Medicaid preferred.
• Minimum two years professional experience with Coordination of Benefits, including order of benefit determination and payment calculation; experience with Texas Medicaid preferred
• Minimum High school graduate or GED required