Full Job Description
TPL & Coordination of Benefits - Specialist
(1 Position located in Baton Rouge)
POSITION TITLE: TPL & Coordination of Benefits - Specialist
POSITION #: 5383
DEPARTMENT: Medicaid Services Contract
Responds to provider, health plan, and member phone calls and correspondence related to the coordination of benefits between Medicaid and other primary insurance sources.
Investigates billing and payment issues including but not limited to denied claims for members with other primary insurance sources.
Serves as the subject matter expert on Third Party Liability (TPL) and Medicare billing. This includes proactively researching and staying up-to-date on any CMS mandated changes for TPL and Medicare billing that would impact Louisiana Medicaid.
Leads in the development and implementation of TPL policies and procedural changes.
Creates and/ or maintains Health Plan Advisories and Informational Bulletins published by LDH related to TPL and Medicare billing.
Ensures the contract language between the State Medicaid agency and the Managed Care Organization (MCO) dictates the terms and conditions under which the MCO assumes TPL responsibility.
Provides oversight of TPL administration and performance activities that are the responsibility of the State’s Managed Care Organizations and are clearly defined.
Updates the State’s federally mandated Third Party Liability Action Plan as necessary to maintain currency of Louisiana Medicaid COB/TPL practices.
Assists with TPL file monitoring activities as needed.
Leads the planning, coordination, and execution of Medicaid TPL Subcommittee meetings.
Serves as the contract monitor for the TPL Recovery and File Maintenance contractor and as such will monitor contract deliverable compliance for both TPL recoveries and file maintenance activities.
Serves as the TPL subject matter expert for Request for Proposal development and contract negotiations.
Responsible for reporting TPL Key Performance Indicators.
Serves as the subject matter expert for TPL Quarterly Financial Reporting with LDH Fiscal Department.
Works effectively and communicates clearly with providers, members, Medicaid staff, contractors, and third party insurance sources.
Other tasks as directed.
Bachelor’s degree or 6 years’ professional work experience in lieu of degree.
Minimum 3 years of professional experience working with Medicare and/or private insurance claims.
Minimum 1 year of professional experience monitoring contracts for deliverable compliance.
Excellent analytical, organizational, communication and time management skills.
Minimum 4 years of professional experience Medicare and/or private insurance claims.
Minimum 2 years of professional experience monitoring contracts for deliverable compliance.
Professional customer service experience.
Professional experience in healthcare billing.
CPT, ICD10 coding and HCPCS knowledge.
CHDA, HIM, RHIA, RHIT, CCA, CMA, CPA, CIA, CGAP, HFMA or other relevant industry certifications.
SALARY: Commensurate with qualifications and experience.
APPLICATION PROCEDURE: Click here to apply.
CLOSING DATE: Position will remain open until filled.
All applicants will be considered for employment without regard to retirement status and without regard to an applicant’s having previously accused the UL System Board or any of its universities of unlawful discrimination. Retirement status shall not be considered in the hiring process by any University in the UL System.
The University of New Orleans is an Affirmative Action/Equal Employment Opportunity employer. Women, ethnic minorities, veterans and persons with disabilities are encouraged to apply.