Coordination of Processor; Managed Care) Remote

Job Summary

Molina Healthcare is hiring for Coordination of Benefits Processor. This role is remote and can be worked from a variety of locations. PST Time Zone is preferred.

• Healthcare Experience
• Administrative healthcare experience
• Solid experience with the MS Office Suite
• High attention to detail
• Solid work history

• Supports multiple Lines of Business (LOBs), including Medicare and Marketplace (MKP)
• Validates external medical and pharmacy coverage through provider portals, outbound calls, and review of Explanation of Benefits (EOBs) to identify and verify other insurance information.
• Researches and validates state, vendor, and internal Coordination of Benefits (COB) leads through insurance carrier outreach and online resources.
• Reviews and interprets EOBs, medical claims, and eligibility information to determine appropriate COB actions.
• Processes provider disputes and submits claim adjustments to ensure claims are paid correctly based on validated COB information.
• Maintains Internal databases and other insurance records to ensure accurate member coverage information.
• Submits ECRS requests to CMS to update external coverage information within the CMS system.
• Maintains compliance with departmental procedures, documentation standards, and regulatory requirements related to COB and Medicare coordination.
• Provides telephone, administrative and data entry support for the coordination of benefits (COB) team.
• Phones or utilizes other insurance company portals to validate state, vendor and internal COB leads.
• Updates the other insurance table on the claims transactional system and COB tracking database.
• Contacts Centers for Medicare and Medicaid Services (CMS) directly, or coordinates with the assigned company contact to log tickets for premium restoration such as Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD).

• At least 1 year of administrative support experience, or equivalent combination of relevant education and experience.
• Customer service skills.
• Attention to detail, organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

• Health care experience.

• Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V