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Grants Pass, OR

497 Union Ave., Grants Pass, Oregon 97527

Medford, OR

3523 Arrowhead Drive, Suite 100, Medford, Oregon 97504

Job Details

Claims Refund and COB Coordinator December 17, 2024

14349338

Located in Grants Pass, OR

Pay: $18.50-$22.00

Job Full Description

The Claims Refund and Coordination of Benefits (COB) Coordinator is responsible for managing the processing and tracking of overpayments, refund requests, and updating member records to ensure accurate Coordination of Benefits (COB). This role involves detailed tracking of refunds, communication with providers, and updating insurance information to ensure claims are paid correctly and in compliance with the refund policy.

Essential Duties:

  1. Maintain logs and reports that track refunded amounts by line of business.
  2. Log inbound refunds accurately and promptly.
  3. Send refund requests identified through staff, reports, and providers.
  4. Follow up with providers who have not responded to refund requests within the designated timeframe.

Key Responsibilities:

  • Claims Identification & Processing: Identify the claim(s) associated with a refund and ensure the refund is applied correctly by logging check details (number, amount, and date received).
  • COB Updates: Verify and update member records for Coordination of Benefits, including checking the COB box when new insurance information is added.
  • Compliance & Procedures: Ensure adherence to desk procedures and HIPAA/PHI compliance guidelines.
  • Communication: Effectively communicate system changes, improvement ideas, and concerns to direct supervisors.
  • Team Collaboration: Respectfully take direction from the Encounter Data Supervisor, VP of Claims Administration, and Claims Processing Manager, and collaborate with team members to foster a provider service-oriented culture.
  • Attendance: Maintain regular and predictable attendance, with the ability to work onsite and remotely as needed.

Education & Experience:

  • High school diploma or GED required; related experience may substitute for education.
  • 6 months to 1-year experience in managed care insurance, Medicare, or Medicaid is required.
  • Familiarity with insurance concepts (co-pays, deductibles, co-insurance, coordination of benefits, pre-existing conditions) is essential.
  • Basic understanding of medical forms (UB04, CMS1500) and medical terminology.

Skills & Competencies:

  • Language Skills: Ability to read, write, and communicate effectively in one-on-one or small group settings.
  • Mathematical Skills: Proficiency in basic math, including computing rates, ratios, and percentages.
  • Computer Skills: Competency in using basic office software, databases, and communication tools.
  • Problem-Solving: Ability to solve practical problems with limited standardization, interpreting various forms of instructions.

Interpersonal Skills:

  • Excellent communication skills and the ability to collaborate effectively with team members and customers.
  • Initiative and Resourcefulness: A proactive attitude in resolving issues with minimal supervision.
  • Professionalism: Demonstrates discretion, tact, and good judgment in stressful situations, interacting positively with upset customers.

Physical & Work Environment Demands:

  • Must occasionally lift/move up to 10 pounds and be able to sit or stand for extended periods.
  • Regular exposure to moderate noise levels.
  • Ability to maintain a high standard of patient confidentiality as required by HIPAA.
  • Ability to work onsite or remotely as needed.

Medford, OR
1951
3523 Arrowhead Drive
Suite 100
Medford, OR 97504

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