Also referred to as:
Benefit Validation Coordinator, Benefits Coordinator - Healthcare, Coordination of Benefits Representative (COB), Patient Benefits/Coverage Coordinator
Requirements and Responsibilities
Coordinator of Benefits Specialist determines the correct order of payment liability when members are covered under multiple insurance plans to ensure claims are paid accurately and in compliance with regulatory and contractual guidelines. Investigates and verifies other insurance coverage by reviewing member records, contacting carriers, employers, and members, and updating coordination of benefits (COB) information in the claims system. Being a Coordinator of Benefits Specialist applies primary, secondary, and tertiary payer rules in accordance with regulations and plan provisions to adjudicate or adjust claims appropriately. Identifies and recovers overpayments resulting from duplicate or out-of-order payments and initiates refund requests or claim adjustments. Additionally, Coordinator of Benefits Specialist resolves COB-related discrepancies and inquiries from members, providers, and internal departments, documenting findings and outcomes in accordance with established procedures. May require a bachelor's degree. Typically reports to a manager. The Coordinator of Benefits Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Coordinator of Benefits Specialist typically requires 2-4 years of related experience.
Find out Job Distribution by:
