POSITION SUMMARY

The Payment Recovery Specialist will be responsible for the recovery of payments of claims related to coordination of insurance benefits, subrogation, and overpayment. Responsibilities will be coordination with other departments regarding recovery of payments and payments to be made, and with external vendors in regard to investigations into subrogation cases and insurance information.

RESPONSIBILITIES

• Processing of overpayments and determination of application of payment to claims and reprocessing as necessary
• Calling other issuers to determine primacy of insurance benefits based on state, federal, and other guidelines related to medical insurance.
• Coordination of external documentation to members, providers, and other external vendors as related to coordination of benefits, overpayments, and subrogation cases.
• Review and analysis of claims to determine if reprocessing due to Coordination of benefits.
• Reporting, tracking, and identification of trends of overpayments, member insurance information, and subrogation case statuses
• Coordination of information between departments of insurance information and overpayments.
• Assist in answering questions from others internally within the department, other departments, and outside vendors.
• Assist in testing for annual upgrades, system changes, program updates and changes, and enhancements as needed.
• Other duties as needed.

KEY COMPETENCIES

People within Community Health Options are expected to work with integrity, humility, strategic vision, curiosity, and discipline. They must be self-motivated, highly effective, and compassionate communicators, effectively leading people, managing work processes, and actively engaging in continuous process improvement.

Health Option diversity initiatives are applicable—but not limited—to our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of diversity equity, which encourages and enforces:

• Respectful communication and cooperation between all employees.

• Teamwork and employee participation, permitting the representation of all groups and employee perspectives.

• Work/life balance through flexible work schedules to accommodate employees’ varying needs.

• Employer and employee contributions to the communities we serve to promote a greater understanding and respect for the diversity.

QUALIFICATIONS

• 3+ years of claim processing experiences or other relevant work
• Ability to do independent work
• Attention to detail and accuracy
• Proven analytical experience
• Proficiency in the Microsoft Office Suite
• Business and technical writing skills
• ICD-10 and CPT coding and billing experience
• Strong relationship-building skills
• Knowledge of CMS, State, and Federal guidelines regarding claim adjudication, recovery, and insurance information.

REMOTE WORKERS: This is a full-time remote position that will require the selected candidate to provide sufficient Internet bandwidth to meet system operational needs, and to have a home office environment that protects the privacy and integrity of confidential information.

SUPERVISED BY: Manager, Claims Operations