Location: Canton,OH, USA
PURPOSE OF POSITION:
The primary purpose of the COB Specialist is to be the centralized source for receiving and inputting COB and other coverage information related updates into the QNXT System. All received information must be date stamped and entered into the system in a timely manner. Timely input of the updates will prevent claims from being denied for this information. The COB Specialist will be responsible for the maintenance of LOI screens. The Specialist will also be responsible to research and follow up on complex COB and related issues. The specialist receives inquiries (calls, referrals and phone sheets) from other departments about COB and COB related questions or issues. The COB Specialist must research and resolve these issues in a timely fashion.
RESPONSIBILITIES & EXPECTATIONS:
* Accurately and promptly enter all COB and other coverage information updates into the QNXT Systems.
* Carefully examine updates and take necessary actions to resolve vague/ unclear responses.
* Specialize in researching and resolving complex COB issues.
* Maintenance of LOI in the QNXT system.
* Coordinate Clean-up projects in relation to the LOI screens.
* Retrieve and track incoming COB and COB related updates.
* Setting up external segments for other AultCare plan, if applicable.
* Cross-over information to other AultCare plan, if applicable.
* Develop and maintain an efficient and organized COB update filing system
* Maintain a follow up file to ensure necessary information is received
* Field calls in relation to COB issues and work toward a quick and accurate resolution.
* Consistently be able to complete routine work in the required time frame
* Performs all duties in an independent manner with little/ no supervision
* Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
* Seeks supervisory guidance/approval as appropriate.
* A sample of the COB Specialists work is quality reviewed as part of the peer audit program. Employees are subject to meet the quality and productivity goals of the department.
* Subject to frequent interruptions and prioritizing of workload.
* Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
* Promotes and demonstrates professional standards to enhance the development of the department.
* Practices ethical conduct.
* Meets acceptable attendance and punctuality expectations (excluding FMLA)
* Meets acceptable productivity and quality standards, as required by the department.
* Conducts scheduled audits of samples of work.
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation.
QUALIFICATIONS:
* High school diploma or GED required.
* Vast knowledge of COB rules, restrictions and limitations is desired.
* Functions independently with flexibility, integrity, and the ability to work effectively and efficiently with all levels of personnel.
* Possesses good interpersonal skills and works well with others.
* Computer experience is required.
WORKING CONDITIONS:
* Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
* Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.
* Sitting/standing/moving about intermittently during working hours.
* Subject to frequent interruptions and changes in priority of duties throughout the day.