PURPOSE OF POSITION:

The primary purpose of the RECOVERY SPECIALIST is to establish a more comprehensive recovery of overpayments resulting from the claim payment system. QNXT has functionality to recover overpayments by provider or member thru a manual or automatic process. The RECOVERY SPECIALIST will accomplish this goal by developed reporting functions. This position entails meticulous attention to detail, ongoing contact with all departments within the organization and strong leadership abilities.

RESPONSIBILITIES & EXPECTIONS:

• Must have a strong background in claims processing and with processing policies and procedures.

• Develop reporting to identify trends, performance measures and opportunities for improvement. This can be for provider billing trends, analyst error trends and system set up trends. This includes review of take back overpayments.
• Work with Data and Reporting to streamline reporting capabilities for the above measures
• Generation of the refund letter when appropriate, based on the report.
• Identify missing attributes which identifies the reason for the refund request.
• Organize monthly meetings to communicate to Provider Relations and Unit Managers trends and opportunities for improvement. Each monthly meeting will include enforcement from the participant’s regarding the progress from the previous month.
• Upon notification of the recovery for the overpayment, the specialist will close the attribute and document the notice of refund form and process the reversal/adjustment in the system as necessary.
• If the recovery is not received within the designated time frame, ensure a second request has been sent. Once two requests have been sent and the recovery has not been received, the specialist will perform a recovery call based on established policies and procedures.
• Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
• Seeks supervisory guidance/approval as appropriate.
• Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
• Promotes and demonstrates professional standards to enhance the development of the department.
• Practices ethical conduct.
• Meets acceptable attendance and punctuality expectations (excluding FMLA)
  
  The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.
  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation.

QUALIFICATIONS:

• High School Diploma or GED required.
• Proficiency with basic math skills.
• Experience: Good key board skills, CRT, CPT Coding, ICD9 Coding, Medical Terminology.
• Experience with Customer Relations
• Leadership abilities.

• Demonstrated team player
  
  WORKING CONDITIONS:

• Normally works eight hours per day. Occasional overtime may be required upon approval.
• Normal lunch periods and breaks.

• Rotation of work from home and office environment.

• Office environment with moderate noise level.
• Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
• Occasionally walking, standing, twisting/turning and reaching upward or forward during work day.