- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
-
L.A. Care Health Plan Los Angeles, United StatesCoordination of Benefits Validation Specialist II · **Job Category**:Administrative, HR, Business Professionals**Department**:Claims Integrity**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:11187**Salary Range**: $50, Min.) - $62, Mid.) - $75, ...
-
Sr. Validation Specialist, IT
2 weeks ago
BioPhase Solutions Los Angeles, United StatesJob Description · Job DescriptionBioPhase Solutions specializes in recruiting top talented professionals for Southern California's Scientific community. We are currently looking for a Sr. Validation Specialist, IT to work for a leading Greater Los Angeles area biopharmaceutical c ...
-
Sr. Validation Specialist, IT
3 weeks ago
BioPhase Solutions Los Angeles, United StatesJob Description · Job Description · BioPhase Solutions · specializes in recruiting top talented professionals for Southern California's Scientific community. We are currently looking for a · Sr. Validation Specialist, IT · to work for a leading Greater Los Angeles area bioph ...
-
Validation Engineer/Specialist
3 weeks ago
VTI Life Sciences Los Angeles, United StatesVTI Life Sciences (VTI) is seeking forward-thinking and ambitious engineers looking to accelerate their career in the pharmaceutical, biotechnology and medical device industries. We offer an opportunity to help support our teams of industry subject matter experts and thought lead ...
-
Data Validation Specialist
3 weeks ago
ServiceTitan Glendale, United StatesWho We Are: · We're FieldRoutes, a leading cloud-based and mobile SaaS provider in the pest control and lawn care industries and a proud member of the ServiceTitan family since 2022. Our cloud-based business management system automates all aspects of field service operations for ...
-
Data Validation Specialist
4 weeks ago
Aston Carter Los Angeles, United States ContractThe company is seeking a data validation specialist to review information to ensure that the company records important details accurately. In this role you will work with electronic records, which can involve sorting and auditing records, reviewing data entries, and updating info ...
-
SilverTech Burbank, United StatesORGENTEC Diagnostika GmbH is a global leader in the development and production of testing systems for the diagnosis of infectious and autoimmune diseases. As part of the Sebia Group, headquartered in Lisses, France, ORGENTEC supplies medical laboratories in over 100 countries wit ...
-
Database Coordinator Ii
3 weeks ago
Volunteers of America Los Angeles Los Angeles, United StatesAbout Us: · **VOALA** · **_Helping Our Most Vulnerable Change Their Life Stories_** · **JOB SUMMARY AND PURPOSE** · The Database Coordinator II oversees and validates the data entered into the Homeless Management Information System (HMIS) and other databases by program staff and ...
-
Certified Peer Support Specialist
2 weeks ago
JWCH Institute Los Angeles, United States**Position Purpose**: · JWCH Institute integrates Certified Peer Support Specialists (PSS) across a range of programs, spanning Behavioral Health, Mental Health, and Substance Use Disorder initiatives, both residential and outpatient. The Certified Medi-Cal Peer Support Specialis ...
-
Business Development Coordinator
2 weeks ago
Airport Marina Honda Los Angeles, United StatesHere at Airport Marina Honda we are strong advocators of career growth and our employees can attest to that Several employees grew their career from entry-level roles including our Finance Manager who started as Internet Sales. Looking for career growth? Come join our team · **Wh ...
-
Peer Support Specialist
2 weeks ago
Painted Brain Los Angeles, United States**Job Classification**:Full-Time (Non-Exempt) · **Supervisor**:Program Director · **Hours**: Up to 40 hrs./per wk. · **Organization Background**: · The mission of Painted Brain (PB) is to create lasting community-based solutions to mental health challenges and the impact of socia ...
-
Assessment Writer
2 weeks ago
Roman Empire Living Skills, Inc Los Angeles, United StatesWe are looking for an experienced assessment writer to join our team Roman Empire has been servicing clients within Los Angeles County for over 10 years We are a growing company and want our employees to grow with us · This position requires communication with direct staff and co ...
-
Peer Support Specialist Supervisor
2 weeks ago
JWCH Institute Los Angeles, United States**About the Company**: · JWCH Institute, Inc. Wesley Health Centers is a private non-profit health agency that is working towards increasing access to high-quality health care resulting in decreased health disparities among at-risk populations through the expansion of comprehensi ...
-
Claims Review Specialist
2 weeks ago
Global IT Resources Los Angeles, United StatesOverview: · We are seeking a highly organized and detail-oriented Claims Specialist to join our team. As a Claims Specialist, you will be responsible for processing and managing insurance claims, ensuring accuracy and compliance with relevant regulations and policies. This is a v ...
-
Data Entry Specialist
2 weeks ago
Atriyo LLC Los Angeles, United States**Hi,** · **Job Title: Data Entry Specialist** · **Location: Los Angeles, CA, 90065(onsite)** · **Duration: 6+months** · We are seeking a diligent and detail-oriented Data Entry Specialist to join our team. In this role, You will be responsible for entering, updating, organizing, ...
-
Production Support Specialist Ii
2 weeks ago
City National Bank Los Angeles, United StatesOverview: · **PRODUCTION SUPPORT SPECIALIST II** · **WHAT IS THE OPPORTUNITY?** · The Production Support Specialist II is responsible for ensuring files are complete with all applicable documentation required for a decision to be rendered prior to underwriting within the Small Bu ...
-
Housing Specialist
3 weeks ago
Project 180 Los Angeles, United States**The Organization** · SSG-Project 180 turns lives around through innovative, wraparound services that keep people out of · institutions and in their communities. Project 180 is a leader in the forensic treatment space, offering · high-quality, specialized treatment programs that ...
-
Betterment Housing Specialist
2 weeks ago
U.S. VETS Los Angeles, United States**BETterment Housing Specialist** · **Level**: Experienced · **Job Location**: USVETS Las Vegas Bonanza - Las Vegas, NV · **Position Type**: Full Time · **Education Level**: 4 Year Degree · **Salary Range**: $ $23.24 Hourly · **Travel Percentage**: Up to 50% · **Job Shift**: · ** ...
-
Loan Intake Specialist
3 weeks ago
Inclusive Action for the City Los Angeles, United States Part time**Los Angeles, California**: · Inclusive Action for the City is a non-profit, community development financial institution (CDFI) whose mission is to serve underinvested communities and build thriving local economies by improving access to transformative capital, and advancing pol ...
-
Executive Protection Specialist
3 weeks ago
Snapchat Los Angeles, United StatesSnap Inc. · is a technology company. We believe the camera presents the greatest opportunity to improve the way people live and communicate. Snap contributes to human progress by empowering people to express themselves, live in the moment, learn about the world, and have fun toge ...
Coordination of Benefits Validation Specialist II - Los Angeles, United States - L.A. Care Health Plan
Description
Salary Range: $50, Min.) - $62, Mid.) - $75, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered under multiple insurance plans. The role involves validating coordination of benefits data, identifying discrepancies, and resolving issues to optimize benefit utilization and minimize costs. The COB Validation Specialist collaborates closely with various stakeholders, including insurance carriers, healthcare providers, and clients to ensure seamless coordination of benefits processing. The COB Validation Specialist conducts outbound calls to members and health plan carriers to validate coordination of benefits information. The Specialist proactively identifies, documents, investigates, and resolves COB issues in a timely and appropriate manner.
Duties
Stakeholder Communication - Facilitate timely outreach and serve as a liaison between insurance carriers, healthcare providers, clients, and internal teams to facilitate effective communication and resolution of coordination of benefits issues. Provide guidance and support regarding coordination of benefits rules, coverage options, and claim submission processes. Conduct outbound calls to members and health plan carriers covered under multiple insurance plans to validate coordination of benefits information. (50%)
Data Validation - Review and validate coordination of benefits data, including insurance policies, coverage details, and claims information. Identify discrepancies and inconsistencies in coordination of benefits data through meticulous analysis and verification. (15%)
Discrepancy Resolution - Investigate and resolve discrepancies in coordination of benefits data, including overlapping coverage, duplicate claims, and payment responsibility conflicts. Collaborate with insurance carriers, healthcare providers, and clients to address discrepancies and ensure accurate billing and reimbursement. (15%)
Quality Assurance - Conduct quality assurance checks to ensure compliance with coordination of benefits regulations, policies, and procedures. Review documentation and reports for accuracy and completeness, making necessary corrections or adjustments as needed. (10%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
Associate's Degree
Education Preferred
Bachelor's Degree
Experience
Required:
1 year of experience in healthcare insurance coordination, claims processing, or data validation.
Experience in Customer Service.
Preferred:
3 years of office experience in Managed Health Care.
Skills
Required:
Solid understanding of standard claims processing, COB guidelines and data analysis.
Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans.
Ability to effectively prioritize and meet deadlines while managing multiple competing tasks.
Must have strong analytical skills.
Ability to work effectively with diverse team members and key internal and external stakeholders.
Excellent communication and interpersonal skills for effective collaboration with stakeholders at all levels.
Detail-oriented with a focus on accuracy and thorough documentation.
Ability to work independently and prioritize tasks in a fast-paced environment.
Proficient with Windows, Microsoft Office programs, and Outlook.
Preferred:
Must be familiar with coordinating benefits between health plan payers.
Knowledge of healthcare insurance regulations and coordination of benefits guidelines.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
