Recovery Audit Specialist

5 days ago


Durham, North Carolina, United States REVCO SOLUTIONS INC Full time
Job Description

At Revco Solutions Inc, we are seeking a skilled Recovery Audit Specialist to join our team. As a Recovery Audit Specialist, you will play a critical role in the recovery of overpayments made to healthcare providers on claims processed by Third Party Administrators (TPA) for self-funded employers.

The ideal candidate will have a collaborative, assertive, and persistent approach while overcoming obstacles for payment of the overpayment. This role owns the process and manages cases with efficiency and exceptional time management.

Duties & Responsibilities:

  • Contact healthcare providers with overdue accounts and attempt to either collect the overdue amount or negotiate a promise to pay plan to collect payments in installments.
  • Locate providers through internet searches and phone calls to update contact information.
  • Resolve provider issues when provider disputes an overpayment request.
  • Continuous reporting on the status of unpaid accounts and any repayment progress.
  • Working on recovery cases under 180 days from providers.

Qualifications/Requirements:

  • Understands medical terminology and can speak to ICD-10 codes, CPT codes, and HCPCS codes.
  • Experience in healthcare claims environment.
  • Expertise with CMS/Medicare and/or commercial insurance reimbursement/payment policies.
  • 2+ years recovery experience with outbound collection calls.
  • Excellent Customer Service skills and interface with Healthcare Providers.
  • Active Coding Certification - CPC, CCS, CMC a plus.
  • Demonstrates excellent organization skills with attention to detail.
  • Proficient in Microsoft Office, including Microsoft Word, Outlook, and Excel.
  • Experience in multi-tasking in multiple platforms and software programs, as well as equipment.

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