Manager Coordination of Benefits Oversight

Role Overview

The Manager Coordination of Benefits Oversight is responsible for overseeing the end-to-end ownership of subrogation case management and Coordination of Benefits (COB) processes for the organization.

Work Arrangement

This is a 100% Remote position but you must live in EST or CST time zones.

Responsibilities

• Vendor Management Strategy for Payment Integrity
• Monitor vendor oversight criteria/metrics for managing vendors to achieve payment integrity results for ACFC
• Ensure all subrogation contract requirements are met
• Participate in all negotiations and work with corporate sourcing to ensure proper contracting/compliance requirements are fulfilled
• Lead or be part of vendor audits on behalf of Payment Integrity
• Maintain accurate Policy and Procedure documents for TPL Ops and subrogation functions
• Gain knowledge in understanding oversight roles as it relates to CMS regulations
• Act as subject matter expert on the state specific rules and regulations around TPL and Subrogation including regulatory reporting
• Recruit, develop, and motivate staff. Continuously improve skill knowledge and staff capabilities

Client Management

• Ensure that the enterprise and its’ subcontractors are performing all required TPL functions when processing claims and properly identifying and recovering on claims not cost avoided
• Responsible for ensuring TPL data provided by states, contracted vendors, and internal/external sources is properly processed and loaded for ACFC plans to be payer of last resort
• Responsible for ensuring subrogation cases are managed and comply with contract requirements, and act as liaison between the Plan and state department’s TPL/Subrogation unit
• Collaborate with regulatory reporting for timely and accurate statutory state reporting

Overall Oversight and Support

• Maintain accurate Policy and Procedure documents for TPL Ops and subrogation functions
• Gain knowledge in understanding oversight roles as it relates to CMS regulations
• Act as subject matter expert on the state specific rules and regulations around TPL and Subrogation including regulatory reporting
• Recruit, develop, and motivate staff. Continuously improve skill knowledge and staff capabilities

Education And Experience

• Bachelor’s Degree and at least five to ten (5 – 10) years’ experience
• Knowledge of claims processing systems. Facets a plus
• SQL query experience
• Knowledge of COB processing rules for Medicaid and Medicare
• Familiarity with SDLC as it relates to developing new systems
• Knowledge of subrogation case rules and regulation for Medicaid, Medicare, and Exchange products
• Ability to develop reports or take existing reports with KPIs and create actionable plans for overall end to end improvements for TPL and Subrogation processes

Our Comprehensive Benefits Package

• Flexible work solutions including remote options, hybrid work schedules
• Competitive pay
• Paid time off including holidays and volunteer events
• Health insurance coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement and more

Benefits

• Communities of Care
• Employee Assistance Program (EAP)
• Disability Insurance
• Life Insurance
• Short-Term Disability
• Long-Term Disability
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)
• Supplemental Health Insurance
• Employee Discounts
• Employee Stock Purchase Plan (ESPP)
• Generous Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Wellness Programs
• Professional Development
• Employee Resource Groups (ERGs)
• Flexible Spending Accounts (FSAs)
• Retirement Savings Plans
• Telemedicine Services
• Prescription Drug Coverage
• Dependent Care Assistance Programs (DCAP)