Summary
The COB Service Representative, Assistant is responsible for recovering payments from commercial insurance carriers that should have paid primary to the Medicaid agency. This role supports revenue recovery efforts by reviewing claims, pursuing appeals, validating eligibility, and ensuring accurate documentation in compliance with contractual and regulatory requirements.
Your Role in our mission:
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Contact insurance carriers via phone and web portals to verify eligibility, determine claim status, assess denials, and pursue appeals or appropriate claim closure.
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Update and maintain accurate case documentation in the case management system, including appeal, denial, and recovery activity notes.
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Respond to carrier inquiries (phone, fax, email), mail form letters, sort and file correspondence, and obtain additional documentation from providers as needed.
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Manage weekly aging reports and pursue outstanding accounts to maximize reimbursement and recovery performance.
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Ensure payers adhere to timely filing requirements and applicable regulations while developing recovery strategies for assigned portfolios.
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Utilize document imaging systems for archival purposes and collaborate with subject matter experts to resolve complex claims.
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Support special projects, limited training initiatives, and other duties as assigned.
What we're looking for:
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High School Diploma or GED required (Associate’s degree preferred) with 2+ years of third-party institutional billing experience and at least 1 year handling claims appeals.
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Strong knowledge of third-party billing, claims processing, EOB interpretation, and UB-04 forms (DSM-IV, CPT, HCPCS, and CMS-1500 preferred).
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Detail-oriented with strong critical thinking, time management, and multitasking skills; able to meet production and quality standards independently and in a team environment.
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Proficient in Microsoft Windows, Word, and basic Excel, with the ability to navigate claims systems and document imaging tools.
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Strong customer service and communication skills with the ability to adapt to change and comply with HIPAA privacy and security requirements.
What you should expect in this role:
- Work schedule expectations: 8-hour shift between 7am – 4:30pm
- Video cameras must be used during all interviews, as well as during the initial week of orientation.
- To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
- To test your internet speed, go to Google and search for “Internet Speed Test.”
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