CWR Medical/Surgical Telemetry (MS Tele) - Per Diem

Supports member outreach activities. Serves as a liaison and resource for other coverage information (OCI) and coordination of benefits (COB) matters. Supports resolution of termination and change requests for OCI. With guidance, contributes to determination and coverage updates to identify primary, secondary, and tertiary coverages. Records OCI/COB information and notes into necessary software, as instructed. Contributes to production data analysis in supports of reporting. Maintains working knowledge of current laws, regulations, and departmental procedures. Under guidance, applies operational policys throughout their work. Follows hands-on guidance to identify areas where claims are being coordinated incorrectly. With guidance, investigates member coverage and/or claims/cases to determine outside payers benefits. Contributes to processing and/or assessment of COB claim/cases. Works with others to identify claim/cases that are COB-related. With guidance, analyzes problem claims/cases and follows up on their implementation. Learns to coordinate with relevant stakeholders. Supports the resolution of inquiries related to OCI. Supports audit processes.

• Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.


• Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.


• Assesses claims/cases in support of COB by: following hands-on guidance to identify areas where claims/cases are being coordinated incorrectly by reviewing information available from all sources; with some guidance, investigating member coverage and/orclaims/cases to determine amount of outside payers benefits; contributing to COB claim/case processing/assessment for timely reimbursement; and working with others to review pending and finalized claims/cases and identify those that are COB-related.


• Contributes to internal coordination by: supporting member outreach activities, such as preparing and/or sending questionnaires to members; serving as a liaison and resource using working knowledge of other coverage information (OCI)/coordination of benefits (COB) for matters between the organization, members, and outside providers; supporting the resolution of termination and change requests for OCI; supporting the identification of training needs for key stakeholders throughout the organization; compiling documentation of industry standards, Medicare guidelines, or other relevant materials for rendering decisions on medical policies or benefits; and, with guidance, contributing todetermination and coordinationof coverage updates to identify primary, secondary, and tertiary coverages.


• Documents and reports on COB processes by: recording OCI/COB information and notes to enter them into all necessary databases/systems, as instructed; NA contributing to production data analysis in support of report development, based on general direction; NA maintaining working knowledge of new and existing case and/or administrative law, benefit administration throughout systems and departments, and changes to regulations and requirements; and incorporating new and updated internal operational policies and procedures under some guidance.


• Investigates inquiries and issues related to COB by: analyzingproblem claims/cases with guidance; learning to coordinate with relevant stakeholders when researching and resolving issues; following up on implementation of recommendations; contributing to inquiries into covered spouse and dependent health coverage; developing working knowledge while supporting resolution of inquiries related to OCI; and supporting audit processes by documenting the process and results.