Manager of Overpayment Recovery Services

Partnership HealthPlan of California•Fairfield, CA

2d•$118,519 - $154,075•Onsite

About The Position

Under the direction of the Associate Director of Internal Audit or above, the Manager of Overpayment Recovery Services is responsible for overseeing the Provider Check Posting and Recovery Teams, while coordinating with administrative support to drive departmental initiatives. This role ensures accurate posting of provider payments, reconciles discrepancies, and manages the recovery of overpaid claims efficiently. The Manager will lead efforts to maintain financial integrity and compliance through effective oversight of claims processing and recovery operations.

Requirements

Minimum five (5) years of progressive experience in healthcare finance or claims processing required
minimum two (2) years of managed care experience, preferably working with Medicaid and/or other government-sponsored programs
or an equivalent combination of education and experience.
Minimum of 3-5 years of experience in a supervisory role required.
Knowledge of managed care finance principles and medical coding, including ICD-9, ICD-10, CPT, and HCPCS.
highly proficient in MS Office with emphasis on advanced use of Excel.
Ability to adapt to new technologies and applications.
Excellent oral and written communication skills.
Strong project management skills.
Ability to work independently to resolve issues.
Ability to work on multiple projects simultaneously, often under strict time constraints and conflicting priorities.
Ability to efficiently coordinate workflow among staff.
Ability to effectively explain complex finance and utilize data in verbal, written, and graphical form.
Ability to use a computer keyboard and 10-key calculator.
Ability to spend more than 70% of work time in front of a computer monitor.
When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs.
Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

Nice To Haves

Bachelor’s degree in finance, Accounting, or related field preferred.
Technical expertise in Business Objects, HighBond by Diligent, and/or ACL for use in data mining, preferred

Responsibilities

Manages the Provider Check Posting Team and Recovery Unit, including recruitment, training, and performance oversight.
Coordinates workflow and delegates tasks to ensure timely and accurate completion of responsibilities.
Directly oversees the quality of work performed by the Cost Avoidance and Recoveries Team.
Prioritizes and delegates tasks and projects.
Posts provider checks and process check reissues.
Reconciles overpayments identified through internal audits and provider refunds.
Prepares and reconciles check postings.
Initiates recovery of overpaid claims and issues refund request letters.
Collaborates with Claims to adjust claims and processes offsets.
Reconciles letters to receivables and creates receivables as needed.
Manages credit balance letters and monitors negative balances.
Collaborates with the FWA team to oversee Fraud, Waste, and Abuse recoupment monitoring activities and reports all recoupments to FWA.
Works with Overpayment Research Unit to identify trends and recommend corrective actions.
Monitors advanced payment and payment plans.
Partners with Finance, Claims, and other departments to ensure accuracy and compliance in payment processes.
Provides reporting on recovery amounts, overpayment reasons, and reconciliation status.
Identifies and implements process enhancements to improve efficiency and accuracy in cost avoidance and recovery operations.
Works with IT to ensure accuracy of downloaded databases related to OHC.
Participates in special projects and assignments as needed.
Other duties as assigned.