Manager Coordination of Benefits Oversight

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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

• Support 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
• Monitor internal and external reports

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
• Leads subrogation specialists and department analysts to ensure that they deliver subpoena requests that are compliant federal, state, and contractual requirements as well as fulfilling key metrics and SLAs by line of business
• 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.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.