Claims Resolution & Recovery Supervisor with Medicare and Medi-Cal experience

Hybrid in Rancho Cucamonga, CA, US • Posted 6 hours ago • Updated 6 hours ago

Contract W2

Hybrid

Depends on Experience

Fitment

Dice Job Match Score™

👾 Reticulating splines...

Job Details

Skills

Claims Resolution
Recovery Supervisor
Auditor
COB
CCS
Medicare
Medi-Cal
Excel

Summary

JOB DESCRIPTION:

Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.

Major Functions (Duties and Responsibilities)

1. Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
2. Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
4. Promote teamwork and maintain effective working relationships with others throughout the organization.

Education & Experience

Four (4) years claims processing experience including Medicare and Medi-Cal
Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
Experience with MS Office applications

Key Qualifications

Strong analytical and problem-solving skills
Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
Microsoft Office including being able to manipulate large data sets in Excel files
Excellent oral and written communication skills

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 90944144
Position Id: 8932219
Posted 6 hours ago

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Claims Resolution & Recovery Supervisor with Medicare and Medi-Cal experience

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