HMO Claims Cost Containment Specialist

Communitycare; Tulsa (OK); On-site; USD 52,000 - 76,000; Full time

Job summary

CommunityCare is seeking a Cost Containment Specialist in Tulsa, OK to ensure proper reimbursement of claim payments. The role involves identifying overpayments, recovering refunds, handling third party liability, coordinating benefits, and reporting on reinsurance.

You will generate and update databases of claims with refunds due, run daily payable reports, communicate with providers about outstanding amounts, and document recovery actions.

Qualifications

• Experience in claims processing and data entry.
• Familiarity with CPT codes and medical terminology.
• Strong mathematical and analytical abilities.
• Proficiency with Microsoft Office and reporting tools.
• Ability to manage time and communicate clearly.

Responsibilities

• Generate and update database of claims with refunds due.
• Run daily reports for future provider payable amounts.
• Access claims and recoup the proper dollar amount; log recovery attempts.
• Communicate with providers regarding outstanding overpayments and maintain logs.
• Reply to calls and emails; update recoupment workflow.
• Generate reports of recouped dollars by line of business and reinsurance amounts.
• Review transplant and Centers of Excellence claim processing.
• Monitor and track reinsurance cases and provide monthly status to finance.

Skills

Claims processing

Data entry

Microsoft Office

Medical terminology

CPT codes

Analytical skills

Attention to detail

Time management

Communication skills

Teamwork

Education

High school diploma or equivalent

Job description

CommunityCare is seeking a Cost Containment Specialist in Tulsa, OK to ensure proper reimbursement of claim payments. The role involves identifying overpayments, recovering refunds, handling third party liability, coordinating benefits, and reporting on reinsurance.

You will generate and update databases of claims with refunds due, run daily payable reports, communicate with providers about outstanding amounts, and document recovery actions.