EugeneRecruiter
the smart solution for Eugene jobs

Coordination of Benefits Representative II

Company: PacificSource Health Plans
Location: Eugene
Posted on: February 15, 2019

Job Description:

Position Overview:

  • Accurately process Coordination of Benefits (COB) claims according to COB policy provisions as stated in plan documents, state/federal regulations and current policies and procedures. Provide COB customer service. Assess current status of COB information and update COB records when new or corrected information is obtained through correspondence and/or personal contact with members, providers, other carriers and internal staff. Essential Responsibilities:
    • Accurately interpret and enter all COB medical, dental and hospital claims data into COB entry screens. Maintain detailed notes regarding COB.
    • Audit auto-adjudicated and electronically submitted COB claims data to ensure accurate processing. Troubleshoot and notify IT if a system problem is found.
    • Maintain member COB status through information received by:
        • Returned COB questionnaires
        • Research on claims submitted with Explanation of Benefits attached
        • Communication with members, providers, other carriers and internal staff.
          • Review and process medical claims pended for "COB Research" role in Facets Workflow.
          • Assist with COB related Customer Service calls.
          • Determine when COB refunds are necessary and communicate information to Claims Audit.
          • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
          • Develop and maintain COB related department policies and procedures.
          • Ability to work independently and make logic based decisions. Supporting Responsibilities:
            • Meet department and company performance, accuracy and attendance expectations.
            • Regularly attend team meetings and daily team Visual Board huddle
            • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
            • Perform other duties as assigned. Work Experience: Two years medical claims or health insurance experience or one year of PacificSource claims experience. Education, Certificates, Licenses: High school diploma or equivalent required. Knowledge: Ability to read and understand health contracts, insurance terminology, benefit language, Explanation of Benefits documentation, COB rules and medical claim forms. Recognizes and understands medical CPT and ICD coding, medical terminology and standard billing practices. Computer skills required, including keyboarding and 10-key proficiency, basic Microsoft Word and Excel. Ability to work under time constraints and quickly understand and apply new information received by phone, correspondence and email. Team player willing to collaborate and help others accomplish team objectives. Medical terminology ICD-9 / CPT coding needed. Prior coordination of benefits and customer call center experience helpful. Competencies Our Values Building Customer Loyalty Building Strategic Work Relationship Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards
              • We are committed to doing the right thing.
              • We are one team working toward a common goal.
              • We are each responsible for our customers' experience.
              • We practice open communication at all levels of the company to foster individual, team and company growth.
              • We actively participate in efforts to improve our communities-internal and external.
              • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence. Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 1% of the time. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

                Keywords: PacificSource Health Plans, Eugene , Coordination of Benefits Representative II, Other , Eugene, Oregon

                Click here to apply!

                Didn't find what you're looking for? Search again!

                I'm looking for
                in category
                within


Other Other Jobs


CDL-A Bulk Service Truck Drivers
Description: CDL-A Company Truck Driver br CDL-A Company Truck Driver Opportunities br James J Williams JJW has safely and--efficiently transported dry and liquid
Company: Trans-System
Location: Salem
Posted on: 02/25/2019

Hiring Now For Part Time Event Specialist
Description: Event Specialist Part Time Sales Are you outgoing, friendly and enjoy meeting new people Our part time Event Specialist jobs are fun and exciting and could be a great fit for you Join our winning team (more...)
Company: Advantage Solutions
Location: Salem
Posted on: 02/25/2019

15T UH-60 Utility Helicopter Repairer
Description:
Company: Army National Guard
Location: Salem
Posted on: 02/25/2019


Uber Eats Part-Time Delivery
Description: Uber Eats Part-Time Delivery Eugene, OR 2854 C1-192641 Delivering with Uber is an easy way to earn money in your spare time. You sign up, deliver whenever it works for you, and get paid every week. Why (more...)
Company: Uber Eats
Location: Eugene
Posted on: 02/25/2019

Truck Driving Jobs - Regional - NEW Pay Guarantee - At Least $1,000/wk!
Description: APPLY TODAY Call to learn more or apply online below 844 754-3475 Truck Driving Jobs - Regional - NEW Pay Guarantee - At Least 1,000/wk Detention pay starts the second you stop - adds up to an extra (more...)
Company: Marten Transport
Location: Corvallis
Posted on: 02/25/2019

Current College Students - Fulfillment Center Operations Intern - Albany, OR
Description: Target is one of the world's most recognized brands and one of America's leading retailers. Our Fulfillment Centers FCs are key to that success, whether
Company: Target
Location: Albany
Posted on: 02/25/2019

Class A CDL Local Company Truck Driving Jobs
Description: GARDNER TRUCKING IS HIRING COMPANY DRIVERSLOCAL AND DEDICATED ROUTES AVAILABLECALL US TODAY 888 346-1575TRUCK DRIVER BENEFITS: Local/dedicated route Home daily Hourly pay up to 22
Company: Gardner Trucking
Location: Eugene
Posted on: 02/25/2019

Bilingual Insurance Representative
Description: As the front line of contact in our Portland service center, insurance representatives do it all from customer service and sales to underwriting and billing. They answer phone calls and solve problems, (more...)
Company: SAIF Corporation
Location: Salem
Posted on: 02/25/2019

Dedicated Company Truck Driver
Description: Call 855-489-7560 ANNUAL SALARY UP TO 70K plus Roadrunner Carriers Offers: Earn 1,200 Per Week plus 3,000 Annual Retention Bonus Per Year .45 CPM
Company: Roadrunner Transportation Systems - Truckload
Location: Salem
Posted on: 02/25/2019

Experienced CDL-A Truck Drivers
Description: Join Swift s Driving Force. Swift values the years of experience under your belt and wants you to join the most powerful fleet on the road. To be a powerful force, you have to take care of everyone that (more...)
Company: Swift Transportation
Location: Salem
Posted on: 02/25/2019

Log In or Create An Account

Get the latest Oregon jobs by following @recnetOR on Twitter!

Eugene RSS job feeds