Coordination of Benefits Representative II
Posted on: June 21, 2022
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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
Diversity and Inclusion: PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and
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
* 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
* Maintain member COB status through information received by:
Returned COB questionnaires.
Research on claims submitted with Explanation of Benefits
Communication with members, providers, other carriers and internal
* 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.
confidentiality and security of protected health information.
* Develop and maintain COB related department policies and
* Ability to work independently and make logic based decisions.
* Meet department and company performance, accuracy and attendance
* Regularly attend team meetings and daily team Visual Board
regulations concerning confidentiality and security of protected
* Perform other duties as assigned.
Work Experience: One year of PacificSource work experience or one
year work experience in a general office role required, or a
combination of equitable work and education experience
Education, Certificates, Licenses: High school diploma or
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-10 / CPT coding needed. Prior
coordination of benefits and customer call center experience
* Building Customer Loyalty
* Building Strategic Work Relationships
* Contributing to Team Success
* Planning and Organizing
* Continuous Improvement
* Building Trust
* Work Standards
Environment: Work inside in a general office setting with
ergonomically configured equipment. Travel is required
approximately 5% of the time.
We live and breathe our values. In fact, our culture is driven by
these seven core values which guide us in how we do business:
* We are committed to doing the right thing.
* We are one team working toward a common goal.
* We are each responsible for customer service.
* 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 many
communities-internally and externally.
* We actively work to advance social justice, equity, diversity and
inclusion in our workplace, the healthcare system and
* We encourage creativity, innovation, and the pursuit of
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.
Keywords: PacificSource, Springfield , Coordination of Benefits Representative II, Other , Springfield, Oregon
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