Claims Refund and COB Coordinator at AllCare Health with the Claims department
We Are Seeking Qualified Candidates to Join Our Team!
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and telecommute, remote work, and flexible schedule options.
Summary
This position is responsible for researching and processing all potential overpayments, refund requests and follow-up contact with providers regarding those requests.
This position is also responsible for ensuring money is correctly applied and refunded to the appropriate claim in a timely manner and in accordance with the refund policy.
Refunds often present with information regarding other insurance for the AllCare member and that member record requires updating with the new information.
Updating the member record will ensure proper Coordination of Benefits (COB) and claims payment.
Essential Duties
Maintain spreadsheet and monitoring logs and reports which track all refunded monies by line of business
Logging the inbound refund in the appropriate locations
Send out refund requests as identified by staff, reports and providers
Follow up calls to those providers who have not responded to the refund request within the listed timeframe
Education & Experience
High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
6 months – 1-year experience in a managed care insurance, Medicare and Medicaid insurance or a combination of those equaling a minimum of 1 year.
An understanding of insurance concepts (co-pays, deductibles, co-insurance, coordination of benefits, preexisting conditions).
Some knowledge of medical terminology.
Some knowledge of medical forms such as UB04 and CMS1500.
Ability to research and resolve errors resulting in refunds and adjustments.
Physical Demands & Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job.
The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms.
The noise level in the work environment is usually moderate.
The employee must be able to work onsite for all scheduled shifts, as needed.
The employee must be able to work from a home office, as needed.
Company Overview
AllCare Health Website: https://www.
allcarehealth.
com.
AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017.
As such, AllCare Health considers its impact on community, society, and the environment in all business decisions.
We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members.
(Learn more about B Corps at https://bcorporation.
net/about-b-corps)
AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views.
This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate.
We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.
The AllCare Health family of businesses is guided by our corporate principles:
Purpose | Working together with our communities to improve the health and well-being of everyone.
Values | Trust, Innovation, Relationships, and Voice.
Vision | Thriving, Inclusive, and Equitable communities.
Brand Promise | Changing Healthcare to Work for You.
AllCare Health is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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