Overpayment Recovery Specialist

CVS Health; Pennsylvania; Híbrido; USD 25.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Descripción de la vacante

CVS Health is seeking a claims recovery professional in Pennsylvania to manage overpayment recovery, conduct provider outreach, and coordinate with internal teams and vendors. The role emphasizes accuracy, adherence to guidelines, and timely follow-ups.

Ideal candidates have 3+ years in medical claims processing and 2+ years in adjustments. This full-time position offers comprehensive benefits and opportunities for training and growth within a large health network.

Formación

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

Responsabilidades

• Review, collect, and resolve overpayment recovery items by phone or written correspondence.
• Partner with internal units and vendors to recover funds and allocate refunds.
• Administer overpayment policies including outreach to members and providers.
• Monitor recovery inventory and complete timely follow-ups.
• Coordinate escalated overpayments with key business functions.
• Analyze alternatives to resolve complex recovery issues.
• Use reports to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations.
• Apply medical necessity guidelines to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments.
• Deliver recovery training to less experienced team members.
• Handle customer service inquiries and issues.

Conocimientos

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Eligibility interpretation

Attention to detail

Multitasking

Educación

Associate degree or equivalent experience

Herramientas

DG system claims processing

Descripción del empleo

CVS Health is seeking a claims recovery professional in Pennsylvania to manage overpayment recovery, conduct provider outreach, and coordinate with internal teams and vendors. The role emphasizes accuracy, adherence to guidelines, and timely follow-ups.

Ideal candidates have 3+ years in medical claims processing and 2+ years in adjustments. This full-time position offers comprehensive benefits and opportunities for training and growth within a large health network.