Financial Recovery

3 weeks ago

New York, United States EmblemHealth Full time

Summary:

- Responsible for Financial Recovery (including Recovery Vendors) and Coordination of Benefits for the organization.
- Collaborate on strategic planning and provide oversight of development and implementation of best practices; establish and then maximize probability for successful achievement of goals and metrics; provide leadership across and with various
internal and external business partners.
- Build relationships with Enterprise provider network (PNM) leaders: Operations, Claims, PFO, Configuration, IT, Medical Economics, etc. across the organization to develop and operationalize recovery and coordination of benefits efforts.
- Partner with organizational leads to influence provider satisfaction by implementing projects and best practices around our policies and financial recovery practices.
- Oversee SLA’s specific to our relationship with CTS; ensure full compliance for state or federal regulations relative to proper financial recovery activities.

Accountabilities:

- Direct all claims payment recovery activities (subrogation, credit balances, payment errors, etc.) to meet established financial targets.
- Responsible for oversight and maintenance of all internal and vendor related workflows and all financial reporting requirements.
- Responsible for the direction of all Coordination of Benefits (COB) activities for the organization including oversight and maintenance of all internal and vendor related workflows.
- Responsible for the direction of the recovery and collections vendor program for the organization. Identify and establish additional recovery vendor relationships in any other “gap areas” of pre
- and post-payment claim recovery.
- Utilize vendor data to identify opportunities to insource processes/functions where appropriate.
- Daily oversight of the Cognizant vendor Financial Recovery and Coordination of Benefits activities; provide feedback to the vendor in support of these activities.
- Responsible for development of an SLA review program.
- Partner with Operations, Payment Integrity, and IT to identify opportunities to improve our processes, our human & technological capabilities in support of reduction of the occurrence of overpayments, and our ability to recover
overpayments which do occur.

**Requirements**:

- Bachelor’s degree in Healthcare, Business, or related field required; Master’s preferred
- 10 - 12+ years of relevant, professional work experience required
- 8 - 10+ years’ experience in a health care environment, preferably including vendor interaction/management required
- 5+ years’ experience managing staff/processes required
- Working knowledge of contracts, SLAs, metrics, and other relevant means to measure performance required
- Working knowledge of applicable regulations, best practices in financial recovery required
- Excellent communication skills (verbal, written, interpersonal, presentation) with all types/levels of audience required
- Ability to effectively negotiate, influence, collaborate and persuade required
- Ability to effectively organize, prioritize, and manage multiple tasks/projects with simultaneous conflicting deadlines required
- Strong analytic, decision-making, and problem-solving abilities required
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
- Demonstrated leadership skills in a matrix environment required

Additional Information
- Requisition ID: 1000001622
- Hiring Range: $86,000-$165,000

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