Job Description

Associate, COB & Recovery

Headquarters Office, 625 State Street, Schenectady, New York, United States of America * Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America Req #1601

Thursday, December 7, 2023

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it\'s time to make a healthy career move to MVP!

Full-Time, Non-Exempt

Investigate, monitor and review other group health coverage that may be primary over MVP plans through various reports and online methods including inbound/outbound calls. Updating and documenting all COB information into member\'s records with information obtained from the investigations and research including other insurance effective/terminated dates, type of coverage, accident dates, diagnosis for related injury and any other information pertinent to the claim and/or case. Applies COB rules and regulations following CMS and NAIC guidelines as well as departmental processes and procedures. Review of claims history for possible claim adjustments requests. Research and respond to all incoming inquiries via claim submissions, correspondence, internal service forms or calls. Working knowledge of Worker\'s Compensation, No Fault, Third Party Liability, Other Insurance and Medicare as it relates to coordination of benefits in determining primacy, application of Explanation of Benefits in secondary benefits claim review, handling and processing of checks, vendor recoveries and calls. Perform collections efforts of all outstanding system negative balances in order to meet and maintain defined departmental goals and standards. Process all returned MVP checks and provider/member refund checks including posting to the claims accounting system. Process and apply all recoveries from various outside recovery/ subrogation vendors including posting to the claims accounting system. Using established procedures, review, monitor and/or investigate aged negative balances through system reports for outreach to providers/facilities and members for collections. Prepare and submit all uncollectable negative balances for collections to outside collections agency. Responsible for the contacting through outbound calls/correspondence to providers/facilities to establish and develop working professional relationships in order to resolve and apply refund balances. Responsible for the adjusting, reprocessing and posting of all refund and or returned checks in the claims system. Responsible for compiling appropriate back up for any and all transactions required to complete the posting and/or admin check requests. (i.e. canceled checks, remittances and copies of claims as needed to support recovery and posting efforts). Handle inquiries from providers/facilities in applying system recoveries as well as resolve inquires and education of the account reconciliation of patients accounts. Resolve COB & Recovery incoming/outgoing calls from internal and external customers by providing professional and knowledgeable customer service to all and meeting departmental standards. Must be able to work additional hours as necessary.

Minimum Education:

AAS in Business or Finance or two years experience in insurance or related field preferred.

Minimum Experience:

Familiarity with CPT-4 and ICD-10 procedural and diagnosis coding and medical terminology. Must be experienced or knowledgeable in one or more of the following areas: No Fault, Workers\' Compensation, Third Party Liability, Medicare and/or other Insurance. Prior experience with Accounts Payable or Finance preferred. Prior COB experience including familiarity with reading various EOB forms highly desirable. Coordination of Benefits experience/knowledge of NYS and Federal regulations pertaining to the order of benefits preferred. Medical claims processing experience preferred.

Required Skills:

• Must have excellent computer skills and proficient in Excel spreadsheets;

• Excellent math and organizational skills;

• Must have outstanding communication skills both written/verbal, interpersonal skills and strong customer service orientation;

• Strong problem solving skills with attention to detail

• Must maintain HIPAA compliance.

• Facets system knowledge a plus.

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com

Please apply and learn more - including how you may become a proud member of our team.

At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors , including but not limited to geographic location ; relevant experience, education, and training; and the nature of and demand for the role.

In addition, we offer a comprehensive benefits package that includes:

• Considerable paid time away from work including PTO (Paid Time Off), s ick t ime, service t ime o ff, p aid h olidays, and f loating h olidays , allowing you to take time off when it suits you best.
• Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
• Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
• Life insurance and disability coverage to ensure financial security for you and your dependents.
• An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
• Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
• A best-in-class employee Well-Being program to support all dimensions of your health and wellness.

MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law.

More detailed information about total compensation and benefits will be provided during the hiring process.

Other details

• Job Family Claims/Operations
• Pay Type Hourly
• Min Hiring Rate $20.00
• Max Hiring Rate $33.12

MVP Health Care