Claims Recoup

**Profile**:
**_Veterans, Reservists, Guardsmen and military family members are encouraged to apply_**

**_ We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)_**

**Job Summary**

Under limited supervision, manages and performs claims department activities related to recoupments and collections, including validation of recoupment setup, conducting collections calls with providers, establishing payment arrangements, tracking and trending outstanding recoupments, establishing payment arrangements, and coordinating collections activities with other departments.

**Education & Experience**

**Required**:

- High School diploma or GED
- 2+ years of healthcare billing or medical claims processing experience
- Claims research skills, to include healthcare policy
- Experience building relationships and using influencing skills
- Experience using Excel to track, trend and report 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**
- Under limited supervision, manages the recoupment process and identifies opportunities for improvements.
- Works with Provider Services, Finance, Legal, and Subcontractors to ensure successful recoupment outcomes.
- Makes outbound calls to providers to notify of and discuss recoupments.
- Coordinates payment arrangements.
- Tracks and advises management of outstanding recoupments.
- Tracks and reports payment plan status.
- Recommends outstanding accounts be set up with collections.
- Conducts complex claims policy research.
- Serves as submit matter expert resource to team members, supervisors, and other management teams.
- Performs other duties as assigned.
- Regular and reliable attendance is required.

**Competencies**

**Commitment to Task**:Ability to conform to established policies and procedures; exhibit high motivation.

**Communication / People Skills**:Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

**Coping / Flexibility**:Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

**Information Management**:Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions.

**High Intensity Environment**:Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

**Organizational Skills**:Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

**Problem Solving / Analysis**:Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

**Technical Skills**:Thorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract.

**Working Conditions**

**Working Conditions**:

- Favorable working conditions in a climate controlled office space; must be available to cover any work shift; works within an office environment with mínimal travel required; level II IT security clearance.
- Extensive computer work with prolonged sitting
- Security clearance as required by contract

**Company Overview**:
**Taking Care of Our Nation’s Heroes.**

**It’s Who We Are. It’s What We Do.**

Do you have a passion for serving those who served?

**Join the TriWest Healthcare Alliance Team We’re On a Mission to Serve®**

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

**Benefits**:
We’re more than just a health care company. We’re passionate about serving others We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

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