Overpayment Recovery Specialist

ISHE; Idaho; Vor Ort; USD 25.000 - 53.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health is recruiting for an overpayment recovery specialist in Idaho. The role focuses on recovering overpayments, allocating refunds, and ensuring compliance while coordinating with internal teams and vendors.

You will perform complex claim analyses and outbound outreach to secure recoveries in a fast-paced environment. The position requires 3+ years of medical claims processing experience, strong attention to detail, and the ability to manage multiple tasks concurrently.

Qualifikationen

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework experience.
• 2+ years in a fast paced, deadline-driven, high-volume environment.
• Experience conducting outbound calls, including provider outreach.
• Experience handling customer service inquiries via phone and/or written correspondence.
• Ability to interpret and apply guidelines related to eligibility, coverage, and benefits.
• Demonstrated ability to manage multiple assignments with accuracy and attention to detail.

Aufgaben

• Review and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal units and vendors to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers and insurers.
• Monitor inventory and follow up to achieve recovery goals.
• Coordinate escalated overpayments with key business functions to drive resolution.
• Analyze and evaluate alternatives to solve complex recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework across dollar amounts with processing expertise.
• Apply medical necessity guidelines and verify eligibility for claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contracts to validate overpayments and refund allocations.
• Deliver recovery training to junior staff.
• Handle customer service inquiries as assigned.

Kenntnisse

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Guideline interpretation

Attention to detail

Ausbildung

Associate degree

Tools

DG system

Jobbeschreibung

CVS Health is recruiting for an overpayment recovery specialist in Idaho. The role focuses on recovering overpayments, allocating refunds, and ensuring compliance while coordinating with internal teams and vendors.

You will perform complex claim analyses and outbound outreach to secure recoveries in a fast-paced environment. The position requires 3+ years of medical claims processing experience, strong attention to detail, and the ability to manage multiple tasks concurrently.