Coordination of Benefits Validation Specialist II Job Category: Administrative, HR, Business Professionals Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11187 Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.Job Summary The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered under multiple insurance plans. The role involves validating coordination of benefits data, identifying discrepancies, and resolving issues to optimize benefit utilization and minimize costs. The COB Validation Specialist collaborates closely with various stakeholders, including insurance carriers, healthcare providers, and clients to ensure seamless coordination of benefits processing. The COB Validation Specialist conducts outbound calls to members and health plan carriers to validate coordination of benefits information. The Specialist proactively identifies, documents, investigates, and resolves COB issues in a timely and appropriate manner. Duties Stakeholder Communication - Facilitate timely outreach and serve as a liaison between insurance carriers, healthcare providers, clients, and internal teams to facilitate effective communication and resolution of coordination of benefits issues. Provide guidance and support regarding coordination of benefits rules, coverage options, and claim submission processes. Conduct outbound calls to members and health plan carriers covered under multiple insurance plans to validate coordination of benefits information. (50%) Data Validation - Review and validate coordination of benefits data, including insurance policies, coverage details, and claims information. Identify discrepancies and inconsistencies in coordination of benefits data through meticulous analysis and verification. (15%) Discrepancy Resolution - Investigate and resolve discrepancies in coordination of benefits data, including overlapping coverage, duplicate claims, and payment responsibility conflicts. Collaborate with insurance carriers, healthcare providers, and clients to address discrepancies and ensure accurate billing and reimbursement. (15%) Quality Assurance - Conduct quality assurance checks to ensure compliance with coordination of benefits regulations, policies, and procedures. Review documentation and reports for accuracy and completeness, making necessary corrections or adjustments as needed. (10%) Perform other duties as assigned. (10%) Duties Continued Education Required Associate's DegreeEducation Preferred Bachelor's DegreeExperience Required: 1 year of experience in healthcare insurance coordination, claims processing, or data validation. Experience in Customer Service. Preferred: 3 years of office experience in Managed Health Care. Skills Required: Solid understanding of standard claims processing, COB guidelines and data analysis. Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans. Ability to effectively prioritize and meet deadlines while managing multiple competing tasks. Must have strong analytical skills. Ability to work effectively with diverse team members and key internal and external stakeholders. Excellent communication and interpersonal skills for effective collaboration with stakeholders at all levels. Detail-oriented with a focus on accuracy and thorough documentation. Ability to work independently and prioritize tasks in a fast-paced environment. Proficient with Windows, Microsoft Office programs, and Outlook. Preferred: Must be familiar with coordinating benefits between health plan payers. Knowledge of healthcare insurance regulations and coordination of benefits guidelines. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)