Provider Refund & Revenue Recovery Specialist

Tenet Healthcare; Honolulu (HI); On-site; USD 30,858 - 46,438; Full time

Benefits offered by this job

Medical, dental, vision, disability, &

Life insurance

Paid time off

401(k) with employer match

Paid holidays

Health savings accounts

Employee assistance program

Voluntary benefits

Job summary

Tenet Healthcare's Conifer Health division seeks a detail‑oriented refunds outreach specialist to manage outstanding refunds for managed groups, engaging with providers and payers on overpaid claims and reimbursement issues.

You will review dashboards, coordinate discrepancies, post refunds in EZ Cap, assist with document management, and support capitation audit processes. A high school diploma is required; a bachelor's degree is preferred, and experience with EZ Cap 6x is a plus.

Qualifications

• High School Diploma or GED required.
• Bachelor’s Degree preferred.
• IPA/Hospital collection experience preferred.
• Experience working with providers and health plans preferred.
• Experience with EZ Cap 6x preferred.

Responsibilities

• Provider outreach for outstanding refunds for all managed groups.
• Engages with providers and payers on issues pertaining to overpaid claims and reimbursement.
• Creates incidents to update issues found regarding contracts, eligibility claims processing.
• Review dashboard to address past-due refund requests and overpaid claims due to system or processing errors.
• Coordinate discrepancies with supervisor.
• Assist with posting refund checks by coding refunds received and entering the amount in EZ Cap for monthly reconciliation.
• Assist with maintenance of the Macess Document Management system.
• Assist with overpayments identified through capitation deduction audits.
• Perform all other job-related duties and special projects as delegated by management.

Skills

Effective writing

Communication skills

Analytical thinking

Matrixed teamwork

MS Office (Word and Excel)

Education

High School Diploma or GED

Bachelor’s Degree preferred

Tools

EZ Cap 6x

Job description

Tenet Healthcare's Conifer Health division seeks a detail‑oriented refunds outreach specialist to manage outstanding refunds for managed groups, engaging with providers and payers on overpaid claims and reimbursement issues.

You will review dashboards, coordinate discrepancies, post refunds in EZ Cap, assist with document management, and support capitation audit processes. A high school diploma is required; a bachelor's degree is preferred, and experience with EZ Cap 6x is a plus.