Benefit and Division of Financial Responsibility Coordinator
UCLA Health
 Los Angeles, CA

The Benefit and Division of Financial Responsibility Coordinator is responsible for determining the criteria loaded into the Benefit module to produce a member's cost share, exclusions, and limits based on the benefit plan. Determines criteria after evaluating Health Plan benefit summaries, evidence of coverage and benefit interpretation resources. Follows departmental procedures to create the benefit package import file for load into the EHR system. You will be responsible for associating the financially responsible entity applied at claim's adjudication to plan covered services within the system (DOFR) module. Responds to written and verbal related inquiries from both internal and external customers in a timely manner. Makes necessary updates as needed to system modules based on research outcomes. Generates reports as needed. Maintains production, service level, regulatory and accuracy standards as defined by the department.

Responsibilities

The Benefit and Division of Financial Responsibility Coordinator is responsible for determining the criteria loaded into the Benefit module to produce a member's cost share, exclusions, and limits based on the benefit plan. Determines criteria after evaluating Health Plan benefit summaries, evidence of coverage and benefit interpretation resources. Follows departmental procedures to create the benefit package import file for load into the EHR system. You will be responsible for associating the financially responsible entity applied at claim's adjudication to plan covered services within the system (DOFR) module. Responds to written and verbal related inquiries from both internal and external customers in a timely manner. Makes necessary updates as needed to system modules based on research outcomes. Generates reports as needed. Maintains production, service level, regulatory and accuracy standards as defined by the department.

Qualifications

We're seeking a self-directed, detail-oriented individual with:

  • High school diploma, GED or equivalent.
  • Two year degree is preferred
  • Minimum of 3 years direct experience in medical benefit verification and interpretation in an HMO environment (i.e. MSO, IPA or health plan)
  • Preferred experience in maintaining benefit plan structures in a managed care transaction system
  • Working knowledge of one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
  • Working knowledge of CPT-4, ICD-9/ICD-10, and HCPCS codes
  • Interpret a variety of instructions furnished in written, oral, diagram form including Health Plan Benefit summaries and (EOC) Explanation of Coverages
  • Able to understand (DOFR) Division of Financial Responsibility documents preferred
  • Proficient computer skills including Microsoft Excel and Word

UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.