Job Details

Job Description Summary

Recovery specialist is responsible for all the claims adjustments recoveries .

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 claim adjustments. 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.
• Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies.
• Works closely with staff from other departments on a regular basis to ensure customer satisfaction.
• Works closely with contract managers to identify and correct contractual issues when applicable.
• 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.
• Researches voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.

• Requires a H.S. diploma; 2-4 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