Overpayment Recovery Specialist

Healthfirst Inc.
Published
April 20, 2021
Location
Lake Mary, FL
Job Type
 

Description

The Overpayment and Recovery Specialist is responsible for processing overpayment recovery of professional, facility and ancillary claims in accordance with Healthfirst Overpayment Recovery Policies and Procedures. In addition, incumbents in this position may also be responsible for handling overpayment provider disputes through resolution, and may assist with overpayment lettering and collections processes related to outstanding overpayment balances.

Duties & Responsibilities:

  • Adjust claims overpaid for professional, facility and ancillary services following overpayment recovery policies and procedures.
  • Review all overpayment recovery cases to determine action to be taken.
  • Investigate and resolve overpayment recovery disputes and correspondence in cooperation with the Claims, Finance and Delivery System Engagement Departments.
  • Elevate any issues to the Overpayment Recovery leader for review. Follow-up on any pending issues in a timely manner.
  • Generate overpayment demand letters within established time frames.
  • Provide feedback to management regarding any issues or repetitive errors that may be encountered during the overpayment recovery claim adjustment process.
  • Ensure appropriate response is provided to any member or provider routed by customer service relating to claims overpayments.
  • Identify trends resulting from provider overpayment recovery inquiries and recommend solutions to reduce volume of disputes and phone inquiries and improve procedures
  • Coordinate with Collections Analysts or Collections Agencies to minimize outstanding overpayment balances due on overpaid claims processed.
  • Coordinate with any offshore vendors as directed, to ensure consistency between teams and accuracy in transactional processing.
  • Respond to any regulatory or compliance requests for information or audits in a timely and accurate manner
  • Assist with generating reports, special projects and other duties as assigned

Minimum Qualifications:

  • High school diploma or GED from an accredited school
  • Health insurance claims processing or related experience with proven track record of excellent Claims Quality results
  • Experience speaking directly with providers and provider billing offices regarding claims issues
  • Basic understanding and experience working with document imaging and workflow routing systems.
  • Basic knowledge of Microsoft Excel and experience working with multiple Excel spreadsheets including filtering and updating of information on a daily basis.
  • Competency with navigating a keyboard and ability to enter data with speed and accuracy.
  • Work experience demonstrating oral and written communication skills.

Preferred Qualifications:

  • Associates Degree from an accredited institution
  • Ability to work under minimal supervision
  • Communicate with skill, tact, persuasion and/or negotiation to accomplish the objectives of the communication.

Compliance & Regulatory Responsibilities: See Above

License/Certification: NA

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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