Claims Recovery Specialist
2 weeks ago
At Call the Car, we are seeking a highly skilled Recovery Specialist to join our Claims Department. As a key member of our team, you will be responsible for ensuring the quality and accuracy of claims processing, while maintaining compliance with State and Federal regulations.
Key Responsibilities- Maintain quality goals and production levels within the Department to ensure quality and production goals associated with each work area are consistently met during regularly scheduled work hours.
- Review monthly eligibility and retro eligibility in order to process claims.
- Review denials for each invoice and report on denial reasons, rebill denials as appropriate, generate amounts to be written off by invoice in a timely manner.
- Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of Call the Car.
- Review and update monthly invoices and communicate any issues that require additional attention to management.
- Follow up on identified issues for resolution in a timely manner.
- Track and trend the metrics associated with the claims adjudication and denial processes.
- Prepare and present written and verbal reports.
- Research concentrated denial reasons within the department or within the systems used by department and identify the root cause of these issues and recommend corrective actions.
- Encouraged to provide recommendations for relevant process and systems enhancements, among others.
- Perform special projects and ad-hoc reporting as necessary. Projects will be complete, and reports will be generated within the specific time frame agreed upon at the time of assignment.
- Working with internal departments to resolve issues delaying claims billing and rebilling or enhancing processing capabilities.
- Assist in testing, changing, analyzing and reporting of specific enhancements.
- High School diploma or GED Required.
- 3+ years processing claims/invoices experience preferred.
- At least 3-5 years of experience as claims examiner working with medical facility claims.
- Experienced in working with Provider Dispute Resolution (PDR's).
- Position requires the ability to multitask in a high production environment.
- Ability to draw conclusions from data analysis and share with management.
- Proficient in using Microsoft Word and Excel.
- Must have excellent written and verbal communication skills with ability to work effectively with diverse team members.
- Ability to research complex claims problems and share with management.
- Must pass a Criminal Background Screening.
- Must pass government exclusion list at time of hire and monthly thereafter.
- Familiarity with various basic PC usage.
- Able to type at least 40 wpm.
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