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Description
Job Description
Job Title:
Overpayment Recovery Specialist
Job ID:
11153
Location: Tampa, FL
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
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Responsibilities
JOB SUMMARY: To identify, track, and reconcile overpayments made to providers ensuring that recovery is made and reported.
PRIMARY RESPONSIBILITIES:
1. Research and identify potential overpayments to providers through independent work, with other departments, or within work groups
2. Prepare and submit in timely fashion productivity and savings reports.
3. Meet or exceed established productivity and quality standards for Financial Accuracy Rate (FAR), Statistical Data Accuracy (SDA), and Overall Accuracy Rate (OAR).
4. Prepare and send correspondence to Providers notifying of claims overpayment(s)
5. Work with Plan(s) regarding overpayment Provider disputes
6. Occasional communication with Providers regarding overpayment disputes
7. Adhere to company and department policies and procedures as well as HIPAA regulations.
8. Other duties as requested or assigned.
EDUCATION AND EXPERIENCE:
Education Required: High school diploma or GED.
Preferred: College Degree
Years and Type of Experience Required: Required:
Minimum of 5 years medical claims processing experience, or
Minimum of 5 years medical billing or collections experience, or
Demonstrated proficiency as an AMERIGROUP Claims Analyst II.
Specific Technical Skills
Required:
Intermediate to advanced level Microsoft Office skills.
Advanced understanding of medical terminology, claims coding, and standard claims forms used for physician and hospital billings.
Preferred: Knowledge of state guidelines and regulations applicable to Medicaid
Other Required:
Strong interpersonal skills
Demonstrates initiative; is proactive in problem resolution; ability to multitask
Able to work independently and use reference material to resolve claims related questions.
Preferred:
SCOPE INFORMATION
Item Measure
# Direct Reports
# Indirect Reports
Budgetary $ Responsibility
PHYSICAL REQUIREMENTS
Must be able to operate a computer, telephone, copier and fax.
Sitting for long periods of time.
Data entry using repetitive motion of fingers and forearms.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
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Details:
Job Id:
755406A0
Posted / Updated:
3/30/2010 3:34:22 AM
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