Recovery Analyst

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this job have the flexibility to work remote from home anywhere in the United States.

One year of claims processing experience or a solid understanding of claims processing preferred.

• Identifies, researches and investigates possible claims overpayments from reports prepared by internal and external sources.
• Determines compliance with benefit plans, provider contracts, and policies and procedures, etc., as they relate to the accuracy of claims payments.
• Summarizes results of research in a meaningful manner that can be used to collect overpayments from providers.
• Interacts with providers regarding collections, adjustments, problems, etc.
• Interacts with outsourced vendors and supports their efforts in the identification of overpayments.
• Reports additional areas where overpayments may have been/are being made noted as a result of performing above work.
• Prepares reports by extracting data in order to be able to investigate additional areas of exposure.
• Controls exception amounts sent directly to providers for collection.
• Reviews cash receipts recorded by Finance for amounts sent in error to other sources.
• Sends timely follow-up letters, records and monitors cash receipts, and issues a report of monthly activity.
• Works with outsourced vendors as required and when receipts are misdirected.
• Interacts with claims adjustment team to ensure adjustment of errors determined during work being performed, especially when reconciliations are required.
• Completes additional responsibilities as required by the department.
• Performs other duties as assigned.
• Complies with all policies and standards.