CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The COB Specialist is primarily responsible for investigating and resolving inquiries with regard to other insurance coverage and updating COB records in Facets and Macess. This includes performing investigation, verification of other insurance, primacy determination and updating the member's COB record. In addition, the COB Specialist will perform all necessary claims adjudication and adjustments required as a result of an update to the member's COB record or as a result of a COB investigation. The specialist will be responsible to contact members, providers and employer groups or brokers, NYS Worker's Compensation Board and other insurance carriers to confirm other coverage and eligibility as needed. The incumbent will work closely with all departments as defined by COB procedures such as Member Services, Provider Services, Claims Operations, Provider Relations and Membership and Billing. The specialist will also send written correspondence to members and providers as required.

QUALIFICATIONS:

• High school diploma or GED required.


• Minimum of one (1) year experience performing coordination of benefits related investigation is preferred.


• Minimum of one (1) year in health care claims review and adjudication to payment/denial utilizing CPT-4, ICD-9/ICD-10 and HCPCS coding preferred.


• Strong product experience is preferred, including but not limited to HMO, EPO, PPO, High Deductible, POS, Self-insured and Government Programs.


• Working knowledge of Microsoft Office applications is required. Experience with a documentation system to track inquiries generated and received and with on-line claims processing and procedural review highly preferred.


• Ability to interpret all CDPHP's health plan contract language, riders, and schedules to make eligibility determinations and verifications based on State statues relating to healthcare administration and corporate guidelines is required.


• Demonstrated ability to determine, analyze and solve problems related to claims adjudication, eligibility, benefits, claims appeals, claims pricing, and COB by utilizing all applicable databases and applications to make determinations is required.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Solutions (PSS), and ConnectRX Services, LLC.