Billing Specialist - Coordination of Benefits (COB)

Job Description

Job DescriptionThe Billing Specialist – Coordination of Benefits (COB) is responsible for managing the full lifecycle of medical claims where patients have multiple insurance plans. This specialist ensures that all primary commercial claims are submitted and adjudicated before cleanly submitting to secondary Medicaid Managed Care Organizations (MCOs). The role requires advanced familiarity with COB policies, payer-specific billing practices, and the use of of a claims management system (ColaborateMD). This position is critical in reducing denials, optimizing reimbursement, and ensuring payer compliance.Responsibilities

COB Intake Validation

• Confirm COB order at intake: commercial as primary, Medicaid MCO as secondary.
• Validate eligibility via 270/271 checks and record insurance sequencing in CollaborateMD.
• Collaborate with patient intake or dental office teams to ensure EOBs and payer data are correctly captured.

Primary Payer Claims Management

• Submit claims to primary commercial payers and track through adjudication.
• Receive, post, and review commercial EOBs.
• Identify patient responsibility, denial reasons, and payer adjustments.

Secondary Claims Management (MCO)

• Generate or trigger secondary claims in CollaborateMD.
• Populate COB fields, including primary paid amounts and appropriate CARC/RARC codes.
• Attach EOBs and supporting documentation in MCO-specific formats (PDF or 835).
• Submit secondary claims to Medicaid MCOs using CollaborateMD clearinghouse.

Denial and Appeals Management

• Work COB-specific denial codes (e.g., CO-109, CO-22, PR-204) and resolve issues preventing payment.
• Coordinate with internal RCM leadership and intake teams to secure missing documentation.
• Submit reconsiderations and corrected claims as needed to MCOs.

Workflow Optimization & Documentation

• Maintain accurate payer and claims notes in EHR/claims management system.
• Identify recurring COB issues and propose workflow improvements
• Ensure compliance with Medicaid/MCO COB policies across states (OH, KY, TN, IL).

Reporting & Audit Support

• Generate reports on COB-related denials, payment lag, and resolution rates.
• Support audit preparation with thorough EOB documentation and accurate insurance records.
• Participate in routine team reviews of billing performance KPIs related to COB processing.

Required SkillsRequired Qualifications

• 2+ years experience in medical billing, with emphasis on secondary/MCO claims and COB workflows
• Proficiency in claims management system usage
• Strong understanding of Medicaid MCO processes, payer-specific claim formatting, and secondary billing workflows
• Familiarity with CPT, CDT, ICD-10, and HCPCS coding practices
• Strong attention to detail and ability to work in a high-volume, deadline-driven environment
• Excellent written and verbal communication skills
• Ability to work cross-functionally

Preferred Qualifications

• Experience with multi-state Medicaid and MCO programs
• Knowledge of payer-specific COB submission rules in Ohio, Kentucky, Tennessee, and Illinois
• Background in dental, anesthesia, or specialty healthcare billing
• Bilingual (English/Spanish) is a plus