Coordination of Benefits Supervisor

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary: 

Responsible for the daily supervision of the Coordination of Benefits (COB) team. This may include distributing daily assignments and monitoring the performance and productivity of the Coordination of Benefits team. Implements policies and procedures and resolves complex issues to ensure accuracy and cost effectiveness. Maintains compliance with state and federal requirements. Supports the Manager in day-to-day operations and focused initiatives. Functions as the liaison between providers and Plan staff as it relates to Coordination of Benefits.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

·       Supervises all activities of the COB staff.

·       Monitors and evaluates the quality, timeliness and accuracy of department processes including claims, appeals, phone calls and COB Medicare files.

·       Monitors and evaluates metrics and quality reports and develops actions plans in conjunction with HR as needed.  Maintains appropriate reporting to assure compliance with all departmental standards and policies.

·       Maintains current, in-depth knowledge of all WellSense benefits, provider network development, contract, configuration issues, Medicaid and Medicare billing practices.

·       Responsible for maintaining accurate and consistent updated OPL policies, processes and procedures and related training manuals.

·       Participates in staff hiring, work allocation and scheduling, training and professional development, performance management and related supervisory activities.

·       Collaborates with other department supervisors in the planning, development and coordination of department specific and cross-functional initiatives.

·       Facilities team meetings.

·       Collaborates with other departments to resolve operational issues.

Supervision Exercised:

·       Supervises staff of 10-20 people

Supervision Received:

·       Indirect supervision is received weekly

Qualifications:

Education:  

·       Bachelor’s Degree in Health Care Administration, Business related field, or an equivalent combination of education, training, and experience is required. 

Experience:

·       6 or more years of experience in a managed care, healthcare, or managed care setting is required.

·       A minimum of 3 years in a leadership role or equivalent training, mentoring, and directing others.

Preferred/Desirable:

·       Experience working in a Manage Care Organization for Mass Health desired.

·       Experience two (2) years Facets/QNXT (TriZetto)       

Certification or Conditions of Employment: 

·       Pre-employment background check

Competencies, Skills, and Attributes:

·       Detailed knowledge of COB payment methodologies, order of benefit determinations, Medicare & Medicaid eligibility rules and industry standard COB practices.

·       Strong investigative, analytic and negotiation skills.

·       Strong working knowledge of Microsoft office products including Word, Excel, and Outlook required.

·       Proficiency in the use of OnBase, Crystal Reports and Facets claim processing system preferred.

·       Excellent communication and interpersonal skills with the ability to lead others.

·       Ability to successfully plan, organize and manage projects.

·       Ability to meet deadlines, multi-task and use appropriate judgment to solve day to day issues.

·       Detail oriented with effective problem solving skills.

·       Ability to adapt with complex changes within the industry.

·       Proven history of excellent customer service outcomes.

·       Ability to train subordinate staff required with the ability to lead and direct others.

Working Conditions and Physical Effort:

·       Regular and reliable attendance is an essential function of the position.

·       Work is normally performed in a typical interior/office work environment.

·       No or very limited physical effort required.

·       No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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