Vacancy caducado!
Description SHIFT: Day JobSCHEDULE: Full-timeFinancial Operations Recovery Specialist II, IIIThis position can sit onsite in any Anthem office or remote. This position can be filled at the level II or level III position and depends on experience and is up to the managers discretion. Financial Operations Recovery Specialist IIResponsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments. Primary duties may include, but are not limited to:
Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research. Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction.
May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.
Works closely with contract managers to identify and correct contractual issues, if applicable.
Handles complex case research and resolution.
May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.
May review and monitor associates work for quality standards.
May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete.
Assists in special projects to find and prevent overpayments and to identify process improvements.
Completes special projects as assigned with minimal supervision.
Researches voluntary refunds for accuracy.
Financial Operations Recovery Specialist IIIResponsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to cash receipts, cash application, claim audits collections, overpayment vendor validation, and claim adjustments Primary duties may include, but are not limited to:
Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.
Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies.
Works closely with staff from other departments on a regular basis to ensure customer satisfaction.
Works closely with contract managers to identify and correct contractual issues when applicable.
May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.
Researches voluntary refunds for accuracy.
Requires accurate balancing of all accounts.
Qualifications Financial Operations Recovery Specialist II
Requires a H.S. diploma; 2-4 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.
Associate degree or higher level degree preferred.
One year minimum of WGS claims processing experience required.
Current working knowledge using WGS required.
Pricing system knowledge with WGS stand alone, ETS Networx Pricer/GA pricing system, Price N Ship/Central Networx Pricing, OHAS preferred.
Financial Operations Recovery Specialist III
Requires accurate balancing of all accounts.
Requires a H.S. diploma; 4-5 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.
Associate degree or higher level degree preferred.
One year minimum of WGS claims processing experience required.
Current working knowledge using WGS required.
Pricing system knowledge with WGS stand alone, ETS Networx Pricer/GA pricing system, Price N Ship/Central Networx Pricing, OHAS preferred.
AnEqualOpportunityEmployer/Disability/Veteran
REQNUMBER: PS36043
Vacancy caducado!