Claims Recovery Specialist

3 weeks ago

Orange, United States Prospect Medical Holdings Full time
Job Description

The Claims Recovery Specialist is responsible for recovering incorrect claims payment to providers. Coordinates and ensures all outstanding over payments are being pursued for recovery purposes. Communicate and explain incorrect claims payments to external providers.

Responsibilities

  • Independently initiate contact with external providers in regards to incorrect claims payment identified by the claims audit team.
  • Clearly communicate and explain reasons for over payment and be able to independently follow up on aged recoveries.
  • Create over payment letters identified by claims auditors and internal departments.
  • Follow up letter or fax must be initiated after 30 days of the first notice sent.
  • Coordinate posting of all checks received with Claims Denial Coordinator and ensure all offset adjustment are received timely from external providers.
  • Checks and offsets received must be posted within 48 hours of receipt.
  • Assist in recovering and reconciling over payments identified by external vendors. Also responsible for contacting providers for possible offset on errors identified on claims checks in review prior to issuance of funds.


Qualifications

One to two (1-2) years experience in managed care. Preferably in an IPA, MSO, or Medical Group setting. Knowledge of CMS and DMHC regulations. Proficient in Excel to include the ability to create and revise Excel spreadsheets to provide accurate and clear reports.One to two (1-2) years experience in recovery and collection preferred. One to two (1-2) years previous experience examining medical Claims preferred.High School Diploma or GEDBachelors degree

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.

  • Claims Recovery Specialist

    2 weeks ago

    Orange, United States CalOptima Full time

    **Claims Recovery Specialist** **CalOptima** **CalOptima Health** is seeking a highly motivated an experienced **Claims Recovery Specialist** to join our team. The Claims Recovery Specialist will be responsible for performing recoveries on claims that have been overpaid and must understand and adhere to recovery regulations mandated by CalOptima Health...

  • Claims Auditor

    24 hours ago

    Orange, United States Prospect Medical Holdings, Inc. Full time

    The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple to...

  • Claims Auditor

    2 days ago

    Orange, California, United States Prospect Medical Holdings, Inc. Full time

    The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple to...

  • Claims Auditor

    3 weeks ago

    Orange, United States Alta Hospitals Full time

    The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple to...

  • Claims Auditor

    3 weeks ago

    Orange, United States Prospect Medical Holdings Full time

    Job Description The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple...

  • Claims Auditor

    1 day ago

    Orange, United States Prospect Medical Holdings Full time

    Job Description The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple...

  • Claims Resolution Specialist

    2 weeks ago

    Orange, United States The Judge Group Full time

    Location: Orange, CA Salary: $24.00 USD Hourly - $33.00 USD Hourly Description: Judge Healthcare is currently seeking Claims Resolution Specialist in Orange, CA!! Contract: 6+ months Hours: Monday-Friday, business hours Location: On-site (Orange, CA) The Claims Resolution Specialist will provide assistance in resolving provider claims payment status...

  • Claims Resolution Specialist

    2 weeks ago

    Orange, United States The Judge Group Inc. Full time

    Location: Orange, CASalary: $24.00 USD Hourly - $33.00 USD HourlyDescription: Judge Healthcare is currently seeking Claims Resolution Specialist in Orange, CA!!Contract: 6+ monthsHours: Monday-Friday, business hours Location: On-site (Orange, CA) The Claims Resolution Specialist will provide assistance in resolving provider claims payment status issues,...

  • Peer Recovery Specialist

    1 month ago

    Orange, United States The Center for Great Expectations Full time

    **Peer Recovery Specialist, START/SBCT Program, Newark, NJ** Grounded in a spirituality that treasures the dignity of all, The Center for Great Expectations seeks to create a safe place, safe presence, and a safe path, that enables clients to experience, choose and maintain physical, psychological, social and spiritual health for themselves, their children...

  • Peer Recovery Specialist

    2 days ago

    Orange, United States The Center for Great Expectations Full time

    **Peer Recovery Specialist, START/SBCT Program, Newark, NJ** Grounded in a spirituality that treasures the dignity of all, The Center for Great Expectations seeks to create a safe place, safe presence, and a safe path, that enables clients to experience, choose and maintain physical, psychological, social and spiritual health for themselves, their children...

  • Claims Resolution Specialist

    3 days ago

    Orange, United States Cross Country Workforce Solutions Group Full time

    Job DescriptionJob DescriptionJob SummaryThe Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Position ResponsibilitiesClaims SupportResponds and researches issues on provider questions regarding claims...

  • Claims Resolution Specialist

    3 days ago

    Orange, United States Cross Country Workforce Solutions Group Full time

    Job DescriptionJob DescriptionJob SummaryThe Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Position ResponsibilitiesClaims SupportResponds and researches issues on provider questions regarding claims...

  • Claims Resolution Specialist

    7 days ago

    Orange, United States Cogent Infotech Corporation Full time

    Job DescriptionJob DescriptionDescription :The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client’s providers. The incumbent will assist providers with questions related to the payment of claims and...

  • Claims Resolution Specialist

    3 days ago

    Orange, United States Cogent Infotech Corporation Full time

    Job DescriptionJob DescriptionDescription :The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client’s providers. The incumbent will assist providers with questions related to the payment of claims and...

  • Peer Recovery Specialist, START Program

    3 weeks ago

    East Orange, United States The Center for Great Expectations Full time

    Job Type Full-time Description Peer Recovery Specialist, START Program Support for mothers with substance use disorders and their children in the community Monday-Friday, 9am-5pm with flexibility in the evenings as needed for recovery meetings Under the supervision of the Site Manager, the Peer Recovery Specialist is responsible for outreach to...

  • Peer Recovery Specialist, START Program

    2 days ago

    East Orange, United States The Center for Great Expectations Full time

    Job Type Full-time Description Peer Recovery Specialist, START Program Support for mothers with substance use disorders and their children in the community Monday-Friday, 9am-5pm with flexibility in the evenings as needed for recovery meetings Under the supervision of the Site Manager, the Peer Recovery Specialist is responsible for outreach to...

  • Claims Resolution Specialist

    3 days ago

    Orange, United States Infoway Solutions LLC Full time

    **Duties & Responsibilities**: **80% - Claims Support** - Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and...

  • Grievance Resolution Specialist

    3 days ago

    Orange, United States Infojini Full time

    Job Summary Seeking a highly motivated and experienced - Grievance Resolution Specialist to join our team. The Grievance Resolution Specialist will be responsible for coordinating the grievance and appeal resolution process. Will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits,...

  • Grievance Resolution Specialist

    2 days ago

    Orange, United States Infojini Full time

    Job Summary Seeking a highly motivated and experienced - Grievance Resolution Specialist to join our team. The Grievance Resolution Specialist will be responsible for coordinating the grievance and appeal resolution process. Will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits,...

  • Grievance Resolution Specialist

    7 days ago

    Orange, United States Sumeru Inc Full time

    **Client: CalOptima Health** **Job Title: Grievance Resolution Specialist** **Duration: 06 Months** **Start Date: ASAP** **Location: 505 City Parkway West, CA (Onsite)** **Position Type: Contract** **Interview Type: In Person/Web Interview** **Ceipal ID: CAL_GAN531_BT** **Job Summary** CalOptima Health is seeking a highly motivated and experienced TEMP -...