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Centene Corporation · 1 day ago

Coordination of Benefits

Missouri, United States

Full-time

Hybrid

Entry Level

$19.43/hr - $32.98/hr

1+ years exp

Centene Corporation is a diversified, national organization that is seeking a clinical professional for their Medical Management/Health Services team. The role involves ensuring accuracy of payments and denials related to Coordination of Benefits (COB) and requires research on dual coverage by other health insurance companies.

Hospital & Health Care

Responsibilities

Calls hospitals, insurance companies, medical groups and/or members requesting other insurance information as it pertains to dual coverage, eligibility and termination dates of coverage

Researches various COB information from lead sources including but not limited to Member Enrollment Forms, returned member request letters, prior claims, authorizations and Call Center Contacts

Makes COB determinations in accordance to COB guidelines (NAIC, CMS, DMHC, DOI or other resources)

Updates the COB master file with other insurance information

Sends correspondence to members requesting COB information

Identifies need to re-adjudicate claims for members when Centene is secondary

Role includes transactional duties related to provider overpayment recovery processes as assigned

Performs other duties as assigned

Complies with all policies and standards