Overpayment Recovery Specialist

CVS Health; New York (NY); Hybride; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking a detail-oriented professional to recover and allocate overpayments, conduct provider outreach, and manage complex refunds. The role supports compliance and works with internal teams to secure recoveries in a fast-paced environment.

You will handle complex reimbursements, review provider contracts, and assist with training to junior staff. This full-time role offers stability, comprehensive benefits, and opportunities to impact patient billing accuracy.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ year of medical claims adjustments and/or rework experience.
• 2+ year of experience 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 a high degree of accuracy and attention to detail.

Responsabilités

• Review, collect, and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers, and insurers.
• Manage overpayment work inventory; monitor progress and follow up to meet recovery goals.
• Coordinate with key business functions on escalated overpayments for resolution.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations across dollar amounts.

Connaissances

Medical claims processing

Provider outreach

Customer service

Attention to detail

Formation

Associate degree or equivalent experience

Outils

DG system claims processing

Description du poste

CVS Health is seeking a detail-oriented professional to recover and allocate overpayments, conduct provider outreach, and manage complex refunds. The role supports compliance and works with internal teams to secure recoveries in a fast-paced environment.

You will handle complex reimbursements, review provider contracts, and assist with training to junior staff. This full-time role offers stability, comprehensive benefits, and opportunities to impact patient billing accuracy.