Recovery Analyst

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

United States, USA

Advantasure

<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p> https://advantasure.com/

keywords: job description,work environment,analysis,support,claims,education & experience,knowledge,skills

Non-Manager

Competitive Compensation and Benefits Package

Overview: <br /> <p>This position is responsible for auditing samples of claims data from opportunity areas in order to qualify and quantify claims overpayments. This role also performs root cause analysis to determine causes of claims overpayments. This position requires a basic working knowledge of health insurance claims processing. The individual must be able to apply Coordination of Benefits/Medicare rules and order of benefit determination. Additionally, this role performs recovery activities to support claim overpayment and reconciliation efforts.</p> <p>&nbsp;</p> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Loads and processes checks related to recovery of overpayments. Reconciles claim adjustments and cash received to recovery submissions.</li> <li>Prepares, tracks, and delivers validated claims adjustment requests to appropriate vendors.</li> <li>Audits data to qualify and quantify claims overpayments. Researches potential recoveries using data from multiple audit files.</li> <li>Conducts comprehensive root cause analysis to identify causes of claims overpayments.</li> <li>Conducts statistically valid audits for confirmed overpayment opportunities to validate savings estimates and root causes.</li> <li>Research claims to validate overpayments &ndash; this research is done by accessing claims processing system so the candidate must have the ability to be able to negotiate through multiple databases and operating systems.</li> <li>Provides help and support to department in quantifying overpayment opportunities.</li> <li>Documents step-by-step audit procedures to be included as part of the overall approach document.</li> <li>Assists in transitioning findings of confirmed overpayments to operations and recovery staff for action.</li> </ul> <p>&nbsp;</p>
Requirements: <br /> <p><strong>EMPLOYMENT QUALIFICATIONS/EDUCATION:</strong></p> <p>&nbsp;</p> <ul> <li>High School Diploma or GED equivalent required.</li> <li>Bachelor&rsquo;s degree in a related field preferred.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <p>&nbsp;</p> <ul> <li>One year of experience in related field required to provide the necessary knowledge, skills, and abilities for the role.</li> </ul> <p>&nbsp;</p> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Strong analytical, reasoning, and critical thinking skills.</li> <li>Strong working knowledge of Microsoft Access, Outlook, Excel, and Word. As well as related software programs.</li> <li>Ability to effectively communicate data results and overall findings to analysis team and other operations and recovery staff as needed.</li> <li>Working knowledge of health claims processing and ability to read explanation of benefit statements from insurance companies.</li> <li>Must be comfortable using various databases and computer systems to research and investigate payment of claims.</li> <li>Ability to independently plan and organize one&rsquo;s own activities</li> <li>Strong problem solving, analytical, and decision-making skills</li> <li>Proven ability to proactively identify and seek out additional information to ensure prompt and accurate resolution</li> <li>Knowledge of related laws, legal codes, government regulations, and applicable CMS policy.</li> </ul>