Overpayment Recovery Specialist - Medical Claims

by dejobs.org

**Overview** Are you a detail-oriented healthcare claims professional with a knack for problem-solving and a passion for ensuring financial accuracy? BroadPath is hiring **Overpayment Recovery Specialists** to join our remote team! As an Overpayment Recovery Specialist, you’ll be responsible for reviewing healthcare insurance claims to identify, validate, and recover overpayments. This is a fully remote position, offering you the flexibility to work from the comfort of your home as part of a collaborative team, dedicated to streamlining processes and maintaining the integrity of claim reimbursements. If you´re ready to make an impact and enjoy the perks of working remotely, we want to hear from you! **Responsibilities** As our Overpayment Recovery Specialist, you´ll be at the forefront of maintaining financial integrity by: + Spearheading the recovery of overpaid claims + Coordinating Third Party Liability recoveries + Tracking refunds and offsets to ensure financial accuracy + Financial Recovery: Lead the charge in collecting funds due to SCCIPA from various overpayment scenarios, including: + Recovering payments for ineligible members + Resolving duplicate claim payments + Addressing incorrect claims handling + Communication Excellence: Craft clear, professional correspondence for refund requests, adhering to AB1455 guidelines. + System Management: Perform precise adjustments and offsets in the claim system as refunds are processed. + Financial Analysis: Track and document financial projections and outcomes of overpayment recoveries, contributing to our organization´s financial health. + Vendor Collaboration: Work closely with contracted vendors to address Third Party Liability issues and recoveries effectively. + Process Improvement: Develop and refine policies and procedures related to overpayment requests, recovery, and financial tracking. + Cross-Departmental Coordination: Create efficient workflows with the Finance Department to ensure seamless tracking of refunds and claim system offsets. + Dispute Resolution: Collaborate with the Audit/Research Department to address and resolve Provider Disputes related to overpayment requests. **Qualifications** + Sharp attention to detail + Excellent prioritization and organizational skills + Ability to interpret basic contractual documents + Strong communication skills and a collaborative spirit + Proficiency in PC applications, including word processing, database, and spreadsheet programs **Education and Experience** + 3+ years of experience as a healthcare claim examiner, preferably in a managed care environment + High school diploma or equivalent required + Prior auditing experience is a plus **Diversity Statement** At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation! Equal Employment Opportunity/Disability/Veterans If you need accommodation due to a disability, please email us at HR@Broad-path.com . This information will be held in confidence and used only to determine an appropriate accommodation for the application process BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law. Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.