Claims Revenue Recovery Analyst - Hybrid/Remote
About The Position
Under the supervision of the Deputy Director of Claims the Revenue Recovery Analyst will follow organization policies and KHS guidelines, Responsible for the recovery of overpayments that get identified due to but not limited to, identifying OHC, Retro disenrollment, CCS eligible conditions, and incorrect payments, Process refunds, reversals and research required to ensure recoveries are accurate, and Reprocessing projects. Will be responsible for maintain check logs, Credit Sheets and Letter and working close with finance. The key purpose of the Revenue Recovery Analyst position is to help coordinate and ensure we are recovering any monies due to KHS.
Requirements
- High school diploma from an accredited school or equivalent.
- Minimum of four (4) years of medical claim payment or medical billing processing experience required.
Nice To Haves
- Prefer two (2) years’ experience performing claims review for error tracking.
Responsibilities
- Credit sheets and credit letters to accounting
- Accounting Logs / Check Logs
- Prepare advances for accounting and apply refund checks to those advances.
- Take EOP vendor calls and assist with EOP questions.
- Provider calls regarding recovery requests.
- Prepare return check letters.
- Post all refund checks received.
- Provider disputes related to recoveries.
- Recovery letters and follow up.
- Follow up calls on non-par providers with outstanding recovery request
- Process recovery claims in claims system
- Refund checks pertaining to TPL.
- Notify Senior Support Staff regarding other potential liability (TPL) for notification to be sent to State (DHS).
- Review negative balance accounts and contact providers for recovery.
- Identify provider billing error trends and report this to supervisor or manager.
- Work with Finance and Corporate Services on return mail/checks regarding provider payments
- Handel all refund checks received for supplemental payments including but not limited to GEMT and Prop 56
- Process claims related to reprocessing projects.
- Work with finance on HFI Medicare recoveries
- Review weekly report for claim processed for EOB when member does not have medical coverage.
- Perform other job-related duties as required.
- Adheres to all company policies and procedures relative to employment and job responsibilities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
