Specialist, Claims Recovery-Spokane Office

Molina Healthcare•Spokane, WA

About The Position

Provides support for claims recovery activities by researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health plans and vendors to facilitate recovery of outstanding overpayments. Monitors and controls claims backlog and workflow, ensuring claims are settled promptly and in accordance with cost-control standards. Prepares provider overpayment notifications and supporting documentation; maintains and reconciles recovery reports; prepares write-off documentation for uncollectible claims; researches claims payments and validates overpayments; enters and updates recovery applications and claim systems; processes refunds and auto debits; follows departmental processing policies and procedures; responds to provider correspondence; collaborates with finance on refund and reimbursement transactions; supports claims efficiency initiatives; meets quality and production standards; and completes basic claims projects as assigned. Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer.

Requirements

At least 1 year of experience in a clerical role in claims and/or customer service, preferably in managed care, or an equivalent combination of relevant education and experience.
Research and data-entry skills.
Organizational skills and attention to detail.
Time-management skills and the ability to manage simultaneous projects and tasks to meet internal deadlines.
Customer service experience.
Effective verbal and written communication skills.
Proficiency with Microsoft Office suite and applicable software programs.

Nice To Haves

Claims recovery experience.
Health insurance experience in a managed care setting.

Responsibilities

Prepare written provider overpayment notifications and provide supporting documentation, including explanation of benefits, claims, and attachments.
Maintain and reconcile department reports covering collected payments, past-due overpayments, uncollectible claims, and autopayment recoveries.
Prepare write-off documents for uncollectible claims and ensure collection efforts are exhausted before seeking approval.
Research claims payments using billing guidelines, claims policies, procedures, and other resources to validate provider overpayments.
Complete basic validation before offsets, including eligibility, coordination of benefits, standard of care, and diagnosis-related group requests.
Enter and update recovery applications and claim systems for multiple states; prepare accurate overpayment notification letters; and process refunds or auto debits in claim systems and recovery applications.
Follow departmental policies and procedures for claims processing, claim recovery, reporting, and documentation.
Respond to provider correspondence about claims recovery requests and remittances where recovery has occurred.
Collaborate with finance to ensure timely and accurate posting of provider and vendor refund checks and manual reimbursement check requests.
Support initiatives to improve claims department efficiency.
Meet claims department quality and production standards.
Complete basic claims projects as assigned.