Recovery Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify, research, and analyze potential claims overpayments from both internal and external reports.

• Assess adherence to benefit plans, provider contracts, and policies and procedures related to claims payment accuracy.

• Summarize findings from research efforts for provider overpayment collections.

• Communicate with providers concerning collections, adjustments, and any issues that arise.

• Collaborate with outsourced vendors to enhance overpayment identification initiatives.

• Report on additional areas where overpayments may have occurred or are currently occurring.

• Generate reports by extracting data to explore further exposure areas.

• Manage exception amounts sent directly to providers for collection purposes.

• Review Finance-recorded cash receipts for any amounts erroneously sent to other sources.

• Dispatch follow-up letters, track and monitor cash receipts, and prepare monthly activity reports.

• Coordinate with outsourced vendors when cash receipts are misdirected.

• Collaborate with the claims adjustment team to ensure that errors are corrected, particularly when reconciliations are necessary.

• Fulfill additional departmental responsibilities and other assigned tasks.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be authorized to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• At least one year of experience in claims processing or a strong understanding of claims processing is preferred.

• Undergraduate degree and/or equivalent experience is required.

• Minimum of one year of experience in a high-production, high-volume environment.

• Capability to identify, research, and investigate potential claims overpayments.

• Familiarity with benefit plans, provider contracts, and relevant policies and procedures concerning claims payment accuracy.

• Proficient in preparing reports through data extraction.

• Ability to engage with providers, outsourced vendors, claims adjustment teams, and Finance personnel.

• Must comply with all policies and standards.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in total compensation.