This position is responsible for the collection of overpaid claims and audit savings identified. This position includes responsibility for assisting with all activities related to bringing the file to resolution, up to and including contacting health plans for bills, researching and approving changes in bill amounts, resolving audit/payment issues, verifying contract information. The Recovery Analyst will utilize both verbal and written communication methods to negotiate and secure repayment of overpaid amounts from Medical Providers, Carriers and Members.
Key Responsibilities and Duties:
* Initiate contact with Medical Providers using both written and verbal communication methods. Maintain a reference table by provider when necessary
* Maintain electronic file information and documentation according to Standard Operating Procedures
* Maximize recovery potential by adhering to Standard Operating Procedures
* Maintain file inventory and successful recovery dollar goals according to Standard Operating Procedures
* Obtain documentation from clients/providers as needed; research client/provider issues
* Resolve issues, including researching contract verification
* Respond in writing to formal provider appeals, following the client and company guidelines for documentation and turn-around-time
* Participate in process improvement initiatives
* Exceed all activity and recovery objectives
Responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, verbally or in writing
Position Qualifications: Knowledge, Skills and Abilities
Qualifications, Skills, and Experience
* Interpersonal Skills: Good oral and basic written communication ability and the ability to communicate effectively with the public and with co-workers
* Knowledge: Knowledge of basic procedures and operations. Ability and judgment to apply procedures or operate varied equipment requiring a moderate degree of previous training or work experience. No supervision of others
* Creativity: Ability to make minor changes. Problems and issues generally fall within a single job area and are well defined
* Level of Responsibility: Direct but closely supervised impact on quality and efficiency of services or operation of company or revenues/expenses. Policies and procedures govern activities. Decisions on all but the most basic problems/issues are subject to prior supervisor approval
* Education & Experience: High school diploma or equivalent
* More than five years of healthcare collections experience required
Negligible travel required.
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* The employee must occasionally position, transport and/or move up to 10-15 pounds
* While performing the duties of this Job, the employee is regularly required to:
* Stand; walk; move about in an office environment;
* Be stationary for long periods of time;
* Use hands to finger, handle, or feel;
* Reach with hands and arms above the head and to ground level;
* Occasionally stoop, kneel, crouch, or crawl or otherwise reach into confined spaces;
* Occasionally push and pull material and equipment from one place to another;
* Communicate with and exchange information verbally and in writing;
* Operate a computer and phone during the work shift;
* Work using repetitive motion
* Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus
* Work requires physical efforts associated with using the computer and phones to access information
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is most frequently in an office environment.
The noise level in the work environment is usually quiet to moderate.
This job description is not intended to describe in detail the multitude of tasks that may be assigned, but rather to provide the incumbent with a general sense of the responsibilities and expectations of his/her position. It is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities or working conditions associated with the position. As the nature of business demands change so, too, may the essential functions of this position.