Claims Recoup

1 week ago


Phoenix, Arizona, United States TriWest Healthcare Alliance Full time

Profile:

Opportunity for Veterans, Reservists, Guardsmen and military family members

Remote Work Available in Several States

Job Summary

Working independently, oversee and carry out claims department tasks related to recoupments and collections. This includes validating recoupment setup, making collection calls to providers, setting up payment plans, monitoring outstanding recoupments, and coordinating collections efforts with other departments.


Education & Experience

Required:

  • High School diploma or GED
  • 2+ years of experience in healthcare billing or medical claims processing
  • Proficiency in claims research and healthcare policy
  • Ability to build relationships and use influencing skills
  • Experience with Excel for tracking and reporting on data

Preferred:

  • Bachelor's (BS/BA) Degree in health care or related field or equivalent experience
  • 2 years of Government claims experience
  • Collections experience
  • Quality or process improvement experience

Key Responsibilities

  • Manage the recoupment process and identify potential improvements
  • Collaborate with key departments to ensure successful recoupments
  • Contact providers to discuss recoupments
  • Arrange payment plans
  • Keep track of outstanding recoupments and payment plans
  • Recommend accounts for collections
  • Conduct in-depth claims policy research
  • Serve as a subject matter expert for team members and management
  • Perform assigned duties and maintain regular attendance

Competencies

Commitment to Task:
Ability to follow established procedures with high motivation.

Communication / People Skills:
Ability to influence others, adapt to different styles, and collaborate effectively.

Coping / Flexibility:

Resilience in adapting to various situations while maintaining a problem-solving approach is needed.


Information Management:
Ability to manage complex information, communicate clearly, and draw conclusions.

High Intensity Environment:
Ability to work in a fast-paced environment, multitask, and maintain focus.

Organizational Skills:
Ability to organize tasks, adjust priorities, and pay attention to detail.

Problem Solving / Analysis:
Ability to analyze processes and solve problems with sound judgment.

Technical Skills:
Knowledge of policies, Managed Care concepts, and medical terminology. Proficiency with coding tools and meeting production standards.

Working Conditions

  • Favorable working conditions in an office environment
  • Extensive computer work and security clearance as necessary

Company Overview:

Dedicated to Serving Our Nation's Heroes.

Join our Team at TriWest Healthcare Alliance We're Committed to Serving
We ensure that America's heroes have access to community healthcare.

Benefits:

We value teamwork and offer various rewards and recognition programs for dedicated employees who are eager to learn and grow within the company.
Our comprehensive compensation and benefits package includes:

  • Medical, Dental and Vision Coverage
  • Generous paid time off
  • 401(k) Retirement Savings Plan with matching
  • Short-term and long-term disability coverage

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