Job Details

Job Description Summary

Payment Integrity team Recovery specialist

How will you make an impact & Requirements

May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claimadjustments. Responsible for the discovery, validation, recovery, and adjustments of claims overpayments.

Primary duties may include, but are not limited to:

• Audits paid claims for overpayments using various techniques including systems based queries, specialized reporting, or other research. Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction.
• May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.
• Works closely with contract managers to identify and correct contractual issues, if applicable.
• Handles complex case research and resolution.
• May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.
• May review and monitor associates work for quality standards.
• May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete.
• Assists in special projects to find and prevent overpayments and to identify process improvements.
• Completes special projects as assigned with minimal supervision.
• Researches voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.

• Requires a H.S. diploma; 4-5 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.
• Associate degree or higher level degree preferred