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Network Health WI · 7 hours ago

COB & Recovery Analyst

Menasha, WI

Full-time

Hybrid

Mid Level

3+ years exp

Network Health is committed to creating healthy communities in Wisconsin. They are seeking a COB and Recovery Analyst to enhance their refund and recovery operations, focusing on Medicare Part D coordination of benefits and developing departmental policies and procedures.

Financial ServicesFitnessHealth CareInsurance

Responsibilities

Maintain reports for tracking voluntary refunds, recoup requests and the negative vendor report

Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management policies, etc

Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution

Reviews and follows up on open work items to ensure resolution is within established timeframes

Works closely with refunds and recoveries to identify root-cause for COB related refunds and recoveries

Assumes responsibility for accuracy, timeliness and efficiency of COB claims following established guidelines

Assist other departments with COB/Medicare Part D appropriate claims payment questions and helps resolve claims adjudication disputes related to COB

Identifies and reports issues with COB/MSP identification or processing training and assists in addressing COB training opportunities

Works professionally with members, employers, providers, other insurance carriers and CMS with regard to verification and update of member information to ensure accuracy

Manage monthly and annual Medicare Part D letters and corresponding updates with ESI

Responsible for complete and accurate documentation of all information received in all applicable member records and databases

Assists leadership in decision-making and provides all relevant information accurately and timely

Ensures department desk procedures related to role are current and complete

Review and respond to CMS Demand Letters for group health plans

Assists in addressing training opportunities

Actively participates in shared accountability and commitment for departmental and organization-wide results. Support departmental/team goals and objective

Qualification

COB knowledgeMedicare Part DClaims processingProcess improvementMS Office proficiencyCustomer service experienceCommunication skillsCritical thinkingDecision-making