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Accounting Clerk

5 months ago

Wheeling, United States The Health Plan of West Virginia Inc Full time
Job DescriptionJob Description

The Funds Recovery Representative is responsible for handling all subrogation recoveries, Claims Audit Recoveries, Amounts paid for Retro-Termed Members and return payments. Also, when needed, will request refunds for claims payment corrections.

Required:

  1. Familiarity with medical terminology and medical claims, effective computer, analytical, organizational and customer skills; experience with computer spreadsheets and word processing.
  2. Excellent telephone skills.
  3. Ability to multi-task.

Desired:

  1. Experience in accounts receivable collections.

Responsibilities:

  1. Identify Eligibility of HP members;
  2. Log all calls on a Service Form in CSR Encounter Form;
  3. Review and process various Reports (e.g. Retro-Termed Members, etc.;
  4. Generate Letters to Members (mainly for Retro-Termed Members);
  5. Send Refund Request Letters to Providers [e.g. Credit Balances Report, Dupe Reports];
  6. Process Collection Notices to Providers;
  7. Process and Submit Accident Reports to Subrogation Vendors;
  8. Process and Post Recoveries (Cash, Voids, Subrogation & Reinsurance);
  9. Perform claim adjustments of Prior Payments;
  10. Balance Recoveries at the End of Each Month;
  11. Manage Calls from Members, Providers and Attorneys regarding Funds Recovery Issues;
  12. Run Required Reports;
  13. Post recoveries from Hospital & Facility Audits;
  14. Manage Hanging Credits and Associated Reports;
  15. Submit Monthly Totals and Reporting to Administration;
  16. Troubleshoot Issues with Vendors or Internal Processes.