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Must be located with 50 miles of Palm Springs, CA.

Description:

Recovery Specialist is responsible for the design, development and maintenance of the processes to maximize recovery of amounts due to DOHC and AZPC (and/or minimize incorrect/inappropriate expenditures) as a result of Claims activities, including but not limited to refund of payments made in error to providers, retro terms, HP cap deducts, erroneous provider billings and focused Vendor audits. The Finance Recovery Specialist will oversee third party vendors who manage provider recoveries and/or third-party liability recoveries. The Finance Recovery Specialist will partner with other members of the DOHC team to obtain necessary information and build reporting to efficiently manage these processes.

• Work with HP information to ensure capitation deductions are appropriate and accurately paid and follow-up on disputes with HP.

• Review CMS Hospice report and recover claims leakage.

• Manage TPL and WC recovery vendor process to ensure maximum recovery.

• Manage DOHC insured services recoveries.

• Identify claim leakage for retro terms and recover from vendor/providers appropriately.

• Follow-up on any claims identified refund request to ensure full recovery.

• Place claim filing for unclaimed payments in California and Arizona.

• Company will provide DOHC laptop to be used at home: Employee will ensure adequate internet and cellular communication available at employee’s expense at telecommute location.

• Perform other duties as assigned.

Skills:

managed care, claims adjudication, claims resolution, claims analysis, health plan, provider claims, icd-10

Top Skills Details:

managed care,claims adjudication,claims resolution,claims analysis,health plan,provider claims

Additional Skills & Qualifications:

• Looking for a minimum of 5 years in managed care.

• Having excel savvy – pivot tables, vlook ups,

• Prefer Coding experience and/or claims experience

• Prefer experience from Health Plan or Medical Group

Experience Level:

Intermediate Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.