Elevate Patient Financial Solutions has an exciting career opportunity available as an Coordination of Benefits Representative. This position will be remote. The Full-Time schedule for this role will be Monday-Friday 8:00am-5:00pm.
Job Summary
The Coordination of Benefits (COB) Representative is responsible for reviewing patient accounts and claims to identify, validate, and sequence primary, secondary, and tertiary insurance coverage in accordance with COB rules and payer contracts. This role ensures accurate payer order, resolves COB-related denials, and coordinates rebilling activities across Medicare, Medicare Advantage, Medicaid, commercial insurance, and third-party liability (TPL) payers to support appropriate and timely reimbursement.
Essential Duties and Responsibilities- Review patient accounts and claims to identify potential primary, secondary, and tertiary insurance coverage, ensuring accurate payer order in accordance with COB rules and payer contracts.
- Validate and maintain accurate insurance information in billing systems, including effective dates, payer order, policy numbers, and subscriber details.
- Resolve claims with COB-related denials by determining correct payer liability and initiating appropriate rebilling or follow-up actions.
- Request, review, and document Explanations of Benefits (EOBs) from primary payers prior to billing secondary or tertiary payers.
- Conducts patient outreach and follow-up to gather information, provide updates, and resolve questions in a timely and professional manner.
- Ensure compliance with payer-specific COB requirements, including Medicare, Medicare Advantage, Medicaid, commercial insurance, and third-party liability (TPL) guidelines.
Claims and Billing Activities:
- Submit corrected or replacement claims when COB errors are identified, ensuring proper payer sequencing, claim frequency codes, and required documentation.
- Coordinate rebilling of claims after receipt of primary payer adjudication, including proper attachment of EOBs and adjustment codes.
- Identify and prevent duplicate or improper billing related to incorrect coordination of benefits.
- Monitor accounts for timely filing requirements across payers and take corrective action to avoid filing-limit denials.
Research and Investigation:
- Conduct in-depth research using internal systems, payer portals, and external resources to determine liable payers for services rendered.
Interdepartmental and External Communication:
- Communicate with insurance carriers, employer groups, and government agencies to verify coverage and resolve payer order disputes.
- Provide guidance and education to internal staff regarding COB rules, payer requirements, and common error prevention.
Productivity and Quality Expectations:
- Maintain assigned account inventories and meet established productivity and quality standards.
- Identify trends in COB denials and escalate systemic issues to leadership for process improvement.
- Other duties as assigned.
Qualifications and RequirementsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required:
- High School Diploma or GED required
- Knowledge of Medicare, Medicaid, commercial insurance, and COB/MSP rules
- Strong analytical and problem-solving skills
- Ability to interpret EOBs, remittance advice, and payer correspondence
- Familiarity with hospital billing systems (e.g., Epic Resolute HB/PB)
- Strong written documentation and verbal communication skills
- Demonstrated comfort with regular patient contact, including outreach and follow-up
- Remote and Hybrid positions require internet connectivity that meets the Company's upload and download requirements.
Benefits:
ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.
- Medical, Dental amp; Vision Insurance
- 401K (100% match for the first 3% amp; 50% match for the next 2%)
- 15 days of PTO
- 7 paid Holidays
- 2 Floating holidays
- 1 Elevate Day (floating holiday)
- Pet Insurance
- Employee referral bonus program
- Teamwork: We believe in teamwork and having fun together
- Career Growth: Gain great experience to promote to higher roles
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
ElevatePFS is an Equal Opportunity Employer