Recovery Specialist

Description:
The Recovery Specialist reports to the Recovery Manager. The incumbent is expected to work independently, with direction from management, to conduct focused audits of all lines of business specifically for the recovery of claims overpayments. Responsible for all activities involved in the recoupment of money from liable parties through auditing, administration of coordination of benefits, subrogation, and workers’ compensation. Individually responsible for annual account specific monetary contribution with regard to claims overpayment. Directly contributes to departmental yearly financial goals and reducing claims liability. Duties include: Identify and recoup claims overpayments due to duplicate payments, terminated coverage, incorrect rates, workers’ compensation, COB, etc. Identify unique avenues for recoupment of unidentified overpayments Respond to service requests from internal customers as well as external Generate refund letters to providers and members as needed Audit high dollar claims for possible overpayments Evaluate and determine primary/secondary COB and load into the in-house claims systems Claims adjudication, specifically to retract/withhold monetary claims overpayments Other duties as assigned
Visit our website at:www.apshealthcare.comReferral bonus available to APS Healthcare Employees*
In accordance to guidelinesAPS HEALTHCARE Bethesda, Inc. and its subsidiaries and affiliates (APS) are Equal Opportunity Employers which employ qualified individuals based upon job related qualifications regardless of race, religion, color, sex, national origin, age, disability, or any other classification proscribed under applicable federal, state, or local law. APS complies with the law regarding reasonable accommodation for disabled employees. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Human Resources in order to arrange such accommodation.
REQUIREMENTS
Requirements:
At least 3 years experience in claims examination functions Knowledge of and ability to use PC based work tools, including, but not limited to, Word, Excel, and Access Ability to function independently and with flexibility in a fast paced environment with constantly changing work demands Excellent interpersonal skills to enhance internal and external working relationships Excellent written and oral communications skills, including the ability to train and to make presentations to internal and external clients Ability to be an effective team member or team leader, based on the demands of a given work situation Ability to analyze, interpret and apply general COB guidelines to specific work situations and make correct business decisions Familiarity with general CPT and Revenue codes with regard to Healthcare Facets Claims Adjudication System knowledge is a plus
Education:
High school diploma