Overpayment Recovery Specialist

CVS Health; Salem (OR); Vor Ort; USD 25.000 - 53.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental and vision benefits

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health seeks a detail-oriented professional to recover and allocate overpaid dollars by coordinating with providers, members, and insurers. This role handles complex refunds, non-routine recovery issues, and ensures compliance and policy alignment throughout the process.

You will work with internal teams and vendors to maximize recoveries, manage inventory, and perform adjustments, with a focus on accuracy and timely follow-ups. A strong background in medical claims processing is essential.

Qualifikationen

• 3+ years of medical claims processing experience.
• 2+ year of medical claims adjustments and/or rework experience.
• 2+ year 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.

Aufgaben

• Review, collect, and resolve overpayment recovery items via phone and written correspondence with limited supervision.
• 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 functions on escalated overpayments to drive resolution and recovery.
• 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 all dollar amounts using claims processing expertise.
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures to support adjudication.
• Process complex provider refunds and returned checks.
• Review and interpret provider contract language to validate overpayments and support refunds.
• Deliver recovery training for less experienced team members as needed.
• Handle customer service inquiries and issues.

Kenntnisse

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Eligibility guidance

Attention to detail

Ausbildung

Associate degree or equivalent experience

Tools

DG system

Jobbeschreibung

CVS Health seeks a detail-oriented professional to recover and allocate overpaid dollars by coordinating with providers, members, and insurers. This role handles complex refunds, non-routine recovery issues, and ensures compliance and policy alignment throughout the process.

You will work with internal teams and vendors to maximize recoveries, manage inventory, and perform adjustments, with a focus on accuracy and timely follow-ups. A strong background in medical claims processing is essential.