Recovery Examiner
4 weeks ago
**Summary**:
**Duties and Responsibilities**:
- Process and post all daily refund checks received.
- Prepares weekly and monthly reports to management of monthly refund requests and refunds received.
- Prepares monthly reports to management and IPA analysts of reconciled reports of refund checks with Accounts Receivables.
- Review refund requests for correct amount and reason.
- Extract and report claim information for data tracking.
- Preparation and mailing of refund request letters to providers.
- Updating claim notes and documentation with refund requests and refunds received information.
- Reviewing, report, and re-request letters of overpayment sent out 30 or more days.
- Investigate and follow up on claims issues regarding overpayments.
- Verify providers pending claims for recoupment by offset.
- Recover money owed by providers on claims by offset.
- Investigate and follow up on provider requests.
- Coordinate daily with multiple departments: claims, A/R, IT, Provider services, eligibility, and others for claims and overpayment information.
- Facilitate calls as needed to verify and/or research claims refund information.
- Perform other related duties as assigned or requested.
**Minimum Job Requirements**:
- AA degree or an equivalent combination of education, training, and experience is required.
**Skills and Abilities**:
- Experience in claims processing/adjusting, health plan, or medical terminology a plus.
- Demonstrates strong understanding and experience using Excel.
- Competency in MS Office and PC skills required.
- Demonstrate organizational, interpersonal and communication skills.
- Ability to perform multiple tasks while maintaining production and quality standards.
**Salary Range**:
- $19 - $22 per hour
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