Claims Recovery Examiner
About The Position
All Care To You is a Management Service Organization providing healthcare administrative support to clients such as Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern, growing company that encourages diverse perspectives and celebrates curiosity, initiative, drive, and a passion for making a difference. The company supports a culture focused on teamwork, support, and inclusion. ACTY is fully remote and offers a flexible work environment and schedules. Benefits include 100% employer-paid medical, vision, dental, and life coverage, as well as paid holiday, sick, and vacation time, and a 401k plan. Additional employee-paid coverage options are available.
Requirements
- Five years' experience processing Commercial, Medi-Cal and/or Medicare or other government agency claims.
- Service/Diagnosis coding experience.
- Knowledge of claims rules and regulation turn around timeframes by line of business.
- Proficient with all Federal and state requirements in claim processing.
- Knowledge of medical terminology and coding.
- Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe.
- Detail oriented and highly organized.
- Strong ability to multi-task, project management, and work in a fast-paced environment.
- Strong ability in problem-solving.
- Ability to self-manage, strong time management skills.
- Ability to work in an extremely confidential environment.
- Strong written and verbal communication skills.
Nice To Haves
- Ez-Cap Experience preferred
Responsibilities
- Reviewing, requesting, and accurately keeping records of claim refunds using Access, Excel, Word, EZ Cap, and medical claims information.
- Assisting in claims audit activities when needed.
- Reviewing incoming recovery checks, closing paid recoveries, and contacting providers with outstanding recoveries.
- Assisting the Finance team with matching bank transactions and bank reconciliations.
- Processing and posting all daily refund checks received.
- Preparing weekly and monthly reports to management on monthly refund requests and refunds received.
- Preparing monthly reports to management and IPA analysts of reconciled reports of refund checks with Accounts Receivables.
- Reviewing refund requests for correct amount and reason.
- Extracting and reporting claim information for data tracking.
- Preparation and mailing of refund request letters to providers.
- Updating claim notes and documentation with refund requests and refunds received information.
- Reviewing, reporting, and re-requesting letters of overpayment sent out 30 or more days.
- Investigating and following up on claims issues regarding overpayments.
- Verifying providers pending claims for recoupment by offset.
- Recovering money owed by providers on claims by offset.
- Investigating and following up on provider requests.
- Coordinating daily with multiple departments (claims, finance, IT, provider network, eligibility, etc.) for claims and overpayment information.
- Facilitating calls as needed to verify and/or research claims refund information.
- Resolving claims issues on identified processing errors and making recommendations for improvements to avoid errors.
- Supporting claims team members to perform any other duties upon request.
- Supporting other departments as needed.
- Performing all other duties as assigned.
Benefits
- 100% employer paid medical coverage
- 100% employer paid vision coverage
- 100% employer paid dental coverage
- 100% employer paid life coverage
- Paid holiday time
- Paid sick time
- Paid vacation time
- 401k plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
