Specialist, COB Recovery (Job ID: 937)

Posted: 07/12/17 | SHARE:


Perform collections efforts of all outstanding system negative balances in order to meet and maintain defined departmental goals and standards. Process all returned MVP checks and provider/member refund checks including posting to the claims accounting system. Process and apply all recoveries from various outside recovery/ subrogation vendors including posting to the claims accounting system. Using established procedures, review, monitor and/or investigate aged negative balances through system reports for outreach to providers/facilities and members for collections. Prepare and submit all uncollectable negative balances for collections to outside collections agency. Responsible for the contacting through outbound calls/correspondence to providers/facilities to establish and develop working professional relationships in order to resolve and apply refund balances. Handle Recovery Unit Call Center calls by providing professional and knowledgeable customer service to all providers/members and meeting departmental standards. Responsible for the adjusting, reprocessing and posting of all refund and or returned checks in the claims system. Responsible for compiling appropriate back up for any and all transactions required to complete the posting and/or admin check requests. (i.e. canceled checks, remittances and copies of claims as needed to support recovery and posting efforts). Handle inquiries from providers/facilities in applying system recoveries as well as resolve inquires and education of the account reconciliation of patients accounts. Research and respond to incoming inquiries via correspondence, telephone or internal service forms. Working knowledge of Worker’s Compensation, No Fault, Third Party Liability, and Medicare as it relates to the handling and processing of checks, vendor recoveries and calls. Backup support to the COB Unit as needed; ie; Call Center calls. Performs other duties as assigned. 


Minimum Education:
AAS in Business or Finance and/or related experience.

Minimum Experience: 

Must have medical claims experience. Claims processing experience strongly preferred. Familiarity of CPT, ICD procedural, diagnosis coding and medical terminology; Prior experience with Accounts Payable preferred; Must maintain HIPAA compliance. Independent Adjusters Certification required. If not certified when hired or transferred into the position; must obtain in next IAC training class.

Required Skills: 

• Must have excellent computer skills and proficient in Excel/spreadsheets;
• Must have outstanding communication, customer service and interpersonal skills;
• Excellent math and organizational skills.
•A strong understanding of the experimental/field marketing and community relations landscape
•Ability to travel throughout the MVP footprint (NYS and VT)
•Ability to work outside the normal workday to implement division and experimental marketing events
•Demonstrates ability to negotiate and build consensus
•Ability to work independently and cross-functionally with other departments
•Experienced in budget management and tracking to goals
•Outstanding organizational skills and the ability to handle multiple tasks and take direction from several internal customers
•Exceptional communication skills including writing, editing, PPT development
•A working knowledge of advertising and sales

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