30 Sep
Financial Operations Recovery Specialist I,II,III
New York, Albany , 12201 Albany USA

Vacancy expired!

Financial Operations Recovery Specialist I,II,IIIJob Family: Finance and Actuarial

Type: Full time

Date Posted:Oct 03, 2022

Req #: JR27656

Location:National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

DescriptionDescription - External$1000 Sign on BonusThis is an opportunity to join a growing team with a focus on Data Mining Claims Validation .As a member of the Prepayment Validation Team, you will review/audit and finalize live claims to ensure accurate application of benefits, pricing and policies for the highest accuracy of claims payments, while helping to reduce provider and member abrasion.As a member of the Post Payment Validation Team, you will review/audit and adjust finalized claims to ensure accurate application of benefits, pricing and policies in order to accurately correct payment and request overpayments.Level IYou will be responsible for the discovery, validation, processing, recovery, and adjustments of claims payments. May do all or some of the following in relation to claim audits, claim payment corrections, overpayment validation, and claim adjustmentsPrimary duties may include, but are not limited to:Reviews and validates Pre-Payment or Post-Payment claims for potential savings opportunities using various techniques including systems-based queries, specialized reporting and/or other research.Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.May do follow up collection activities to ensure the recovery of overpayments through Host Plans.May require verification with host plans adjusting claims through the ITS and WGS systemsLevel IIAll of Level I plus:Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies, more advanced concepts including correcting ITS Home claimsMay work projects and/or emails as assigned by Leads.Level IIIAll of the above plus:Works closely with staff from other departments on a regular basis to ensure customer satisfaction.Works closely with contract managers to identify and correct contractual issues when applicable.Identify and present opportunities for team and/or concept improvementsMay work with BA’s and other teams on concept improvements and/or documentation improvementsMentor/train/shadow new hiresMay participate in issue discussions for resolutionsQualifications - External:Level IRequired QualificationsHighschool Diploma1 year of medical claims processing experience and/or customer service; or any combination of education and experience, which would provide an equivalent background; i.e. experience from other Health Plans, Hospitals and/or Medical Groups.Preferred QualificationsAA/AS or higher level degree preferred.Knowledge of ICD10, CPT, and HCPC codes preferred.Member benefit and provider contract language knowledge preferred.Level IIRequired QualificationsHigh School Diploma2 years of WGS claims processing experience; or any combination of education and experience, which would provide an equivalent backgroundPreferred QualificationsAA/AS or higher level degree preferred.Knowledge of ICD10, CPT, and HCPC codes preferred.Member benefit and provider contract language knowledge preferred.Level IIIRequired QualificationsHigh School Diploma4 years of WGS claims processing experience; or any combination of education and experience, which would provide an equivalent backgroundPreferred QualificationsAA/AS or higher level degree preferred.Knowledge of ICD10, CPT, and HCPC codes preferred.Member benefit and provider contract language knowledge preferred.Applicable to Colorado Applicants OnlyHourly Pay Range: $18.08/hr - $27.40/hr (Min – MRP)Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Be part of an Extraordinary TeamElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.EEO Policy Statement

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