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Collections Associate - 32087-1

Monterey Park, CA 91755 | Contract

Job ID: 56768 Branch: Rancho Cordova

Healthcare Claims Analyst Needed

GENERAL SUMMARY:

The Claims Recovery Analyst is responsible for making sure all identified claims overpayments are processed accurately and within regulatory timeframes. Accurate processing of overpaid claims includes but not limited to research and validation of original claims payment for accuracy, creation and mailing of overpayment refund letters and maintenance of overpayment recovery logs and/or database. The Analyst must understand all the claims processing requirements which include but not limited to coordination of benefits and contract interpretation.

QUALIFICATIONS:

• Minimum 1-2 years medical claims overpayment recovery experience and 2-3 years medical claims examining experience, or equivalent of the two

• 2 or more years experience in managed care organization a plus

• Must be familiar with coordination of benefits processes and related regulatory requirements

• Must be familiar with Medicare/Medi-Cal crossover claims processes

• Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus

• Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements a plus

• Advanced proficiency in Microsoft Word and Excel; Access knowledge a plus

• Minimum typing speed of 45 WPM and use of Ten-Key by touch

• Ability to write analytical reports and comprehensive summaries

• Must be detail oriented

• Ability to effectively communicate with internal and external associates

• Ability to deal with complex claim issues

• Knowledge of DMHC, DHS, CMS, Title XX II CRC, Title 42, and Medi-Cal and Medicare processing guidelines a plus

• Ability to work in a fast pace environment with minimal supervision

• Ability to handle multiple projects and is able to prioritize workflow

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews refund request logs, account receivable reports, open invoice accounts or other similar reports to ensure appropriate vendors with negative account are correctly classified in designated system/database.

• Reviews reports of potential claims overpayment to ensure requests for reimbursement of overpaid claims are made and processed accurately and timely. Reports include but not limited to payment of claims to retro disenrolled members and audit reports.

• Enters overpaid claims information into designated recovery database, generates and mails refund request letters accurately and ensure compliance to regulatory timeframes

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

• Reviews all identified overpayments to determine whether claims overpayments are due to system configuration, training issues or erroneous claims processing. .

• Works with providers who call, send emails or faxes overpayment issues and communicate either telephonically or in writing about the findings.

• Works closely with recovery vendors, work include but not limited to: o Reviewing identified overpayments and when necessary validates accuracy of vendors’ findings;

o Communicating either telephonically or in writing about their findings

• Processes claims payment reversals

• Works closely with other departments such as Accounting, Provider Dispute Resolution (PDR) and Provider Data and Configuration Management (PDCM) to ensure overpaid claims are appropriately processed.

• Conducts analyses to identify root causes of overpayments/incorrect payments and communicates findings to Claim Management.

• Generates statistical reports for trending.

• Maintains productivity and quality standards as defined by Management.

• Contacts providers either telephonically or in writing for additional information.

• Complies with company’ s attendance and punctuality standards.

• Promotes teamwork and cooperation with other staff members and management.

• Performs additional related duties as assigned by Management.

Job Type: Full-time

Salary: $14.00 to $16.00 /hour

Alana Klingman
Recruiting Manager

Alana is a native Huntington Beach resident making the move to Sacramento just a few years ago. She comes with over 15 years of experience in full cycle healthcare recruiting and thoroughly enjoys every aspect of her job. Receiving a new client order and placing a qualified applicant is truly an excitement each and every time. Her goal at the end of every day is to leave a positive impression with everyone she works with including letting the candidates know that she is on their side. She strives to fill every client need that comes across her desk with a candidate that can call that place of business HOME. When she is not hard at work Recruiting, Alana spends her free time attending local family events, trying new eateries and perfecting DIY home projects she found on Pinterest.

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