Claims Recovery Specialist Anywhere in the U.S. -USA-Job-ID-8066

by

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Claims Recovery Specialist is responsible for processing of all identified claims overpayments within the regulatory and/or contractual timeframes. Ensures claims overpayments are recovered timely and accurately. Understands claims processing requirements which include but not limited to interpretation of contracts and benefits, correct claims coding and billing. Maintains and tracks all incoming refunds and overpayment identified internally and by the contracted recovery vendors.

General Duties/Responsibilities (May include but are not limited to):

1. Reviews system generated report for potential overpayment and ensure identified claims overpayment is processed timely and accurately

2. Processes identified overpayments in designated recovery database and claims processing system timely and accurately

3. Generates and mails overpayment recovery letter/demand letter and ensures reason for recovery is clearly communicated to provider

4. Responds to provider inquiries, either telephonically or in writing, regarding overpayment refund requests

Other Posts You May Be Interested In

5. Collaborates with Audit team in ensuring claims payment errors which results in overpayments are recovered timely

6. Collaborates with other department in resolving potential configuration issues and updates on eligibility and other insurance information

7. Researches returned claim checks from providers/vendors, voided checks or letters from providers regarding identified overpayments

8. Assists with implementation and management of contracted overpayment recovery vendors and subrogation9

9. Works with recovery vendors in ensuring identified overpayments are accurate

10. Reviews and submits vendor invoices timely and ensure accurate payment request is submitted

11. Reviews overpaid claims and determines if root cause is due to system configuration, training issues or erroneous claims processing

12. Communicates root causes and issues that impact claims processing quality to Management

13. Generates reports based on recovery findings for training opportunities and process improvements

14. Generates weekly/monthly reports for recovery tracking and trending

15. Ensure the privacy and security of PHI (Protected Health Information) as outlined in the department policies and procedures relating to HIPAA Compliance

Supervisory responsibilities:

N/A

Job Requirements:

Minimum Experience:

Required: 2+ years claims examining all types of claims (professional, facility, ancillary), preferably in Medicare Advantage delegated model

Required: 2+ years’ experience in claims overpayment recovery, preferably in Medicare Advantage setting

Education:

Required: High school diploma or GED

Preferred: Bachelors degree in healthcare management or related field

Specialized Skills:

  • Knowledge of claims processing systems (EZCAP preferred)
  • Working knowledge of different claims coding requirements, payment methodology (PPS, Medicare fee schedules, etc.), coordination of benefits
  • Understanding of Division of Financial Responsibility on how they apply to claims processing
  • Intermediate to Advance proficiency in MS Office products – Word, Access and Excel Comprehensive knowledge of Medicare Advantage claims processing requirements and other related regulatory requirements
  • Knowledge of medical terminology
  • Identifies and resolves problems in a timely manner
  • Gathers and analyzes information skillfully

Licensure:

Required: None

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $53,210.00 – $79,815.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

Leave a Comment

Who we are

Welcome to careers.techlabrepairs.com, the premier platform designed to streamline your job search across the internet. Our objective is clear: to enhance the job-seeking experience by consolidating job listings from various reliable sources into one accessible location, ensuring a wealth of opportunities is just a click away.
In the current fast-paced environment, job hunting can be daunting. With numerous job boards, recruitment firms, and corporate career pages to navigate, identifying the ideal position often becomes a laborious task. This is where we come in. At careers.techlabrepairs.com, we have developed a website that compiles job listings from a diverse array of reputable sources, reducing the time and effort required to find your next career opportunity.

Our Vision
Our vision is to offer job seekers a seamless and efficient pathway to discovering top-tier employment opportunities. Recognizing that each job seeker has unique preferences and requirements, we strive to provide a platform with a comprehensive range of job listings catering to the diverse needs of all professionals.
We advocate for a job search process that is straightforward and accessible. By aggregating listings from leading job boards, corporate career sites, and recruitment agencies, we simplify the process of finding roles that align with your skills, experience, and career aspirations. With careers.techlabrepairs.com, there's no need to jump between different websites—everything you require is right here.

Why Choose Us?
Comprehensive Listings Our platform gathers job listings from trusted sources across the web, ensuring access to a vast array of opportunities. Whether you seek remote work, freelance projects, part-time roles, or full-time positions, we provide options across numerous industries, from technology and healthcare to marketing and finance, ensuring you find the perfect match for your expertise.

User-Friendly Experience
Navigating job listings should be straightforward, not burdensome. Our user-friendly interface facilitates easy searching, filtering, and application processes. Our search functionality allows you to refine listings by location, job type, salary range, and more, enabling swift identification of positions that meet your criteria.

Up-to-Date Listings
We maintain a platform that reflects the latest job openings by regularly updating our listings. This ensures access to fresh job postings, providing you with a competitive advantage in the job market.

Tailored Results
Utilizing advanced algorithms, our platform delivers personalized job recommendations based on your preferences and search history. By understanding your career objectives, we present the most relevant opportunities, helping you find the best positions swiftly.

For Employers & Recruiters
careers.techlabrepairs.com serves not only job seekers but also employers and recruiters, offering a robust platform to showcase job openings to a wide and diverse audience. By posting listings on our site, you can reach a larger pool of qualified candidates, facilitating a quick and effective connection with top talent. Our mission is to assist employers and job seekers in making the perfect match, enhancing the hiring process's efficiency and dynamism.

Our Commitment
At careers.techlabrepairs.com, we are dedicated to making the job search process smoother for everyone. We aim to provide accurate, reliable, and current job listings in a user-friendly environment. Understanding the challenges of job searching, we are here to support you at every stage. Whether embarking on your career journey or seeking advancement, careers.techlabrepairs.com is committed to helping you thrive.

Thank you for choosing us as your trusted partner in job search. We look forward to assisting you in finding the ideal job and advancing your career to new heights.

Disclaimer: Job Posting Sources

Various reliable job search engines, such as Indeed, LinkedIn, ZipRecruiter, CareerBuilder, Monster, Glassdoor, Getwork, Snagajob, and FlexJobs, are the source of the job postings on our platform. Although we make every effort to present accurate and current information, we are unable to guarantee the accuracy, completeness, or dependability of the job postings from these outside sources.

When applying for jobs found on these platforms, users are advised to perform their own due diligence. We are not liable for any errors, omissions, or inaccuracies in the job postings, and neither do we support any particular employer or job posting.

Additionally, please be aware that job listings may change without warning and that some may not be relevant or active at the time of viewing.

Users who access job postings from these outside sources through our platform consent to indemnify us for any liability resulting from the use of such information.