Senior Claims Recovery & Overpayments Analyst

EmblemHealth; New York (NY); Presencial; USD 56.000 - 99.000; Jornada completa

Descripción de la vacante

EmblemHealth seeks a Recovery Auditor to proactively assess vendor performance, monitor daily recovery activities, and engage with providers to recover overpayments. The role involves analyzing claims, eligibility, contracts, and reimbursement methods to identify recovery opportunities and improve accuracy.

The candidate should have 3–5+ years of healthcare recovery/auditing experience, expert knowledge of MSP/COB, and strong analytical and communication skills to collaborate across Claims,

Formación

• 3 - 5+ years of relevant experience in auditing and financial recovery in a healthcare provider environment.
• Experience with MSP and COB, provider and member recoveries, and overpayment investigations.
• Experience interpreting CMS regulations, provider contracts, and reimbursement methodologies.
• Ability to perform independent research using multiple sources.
• Strong collaboration and communication skills.

Responsabilidades

• Assess and monitor vendor performance to meet contractual targets and quality expectations.
• Investigate and analyze claim overpayments and drive timely closure of balances.
• Develop action plans with internal/external partners to resolve issues and prevent recurrences.
• Analyze recovery data to identify trends and provide recommendations for improvements.
• Collaborate with multiple departments to resolve complex recovery issues.

Conocimientos

Auditing

Financial recovery

Healthcare experience

CMS regulations

Root cause analysis

Communication

Collaboration

Analytical thinking

Problem solving

Project coordination

Educación

Bachelor's degree

Descripción del empleo

EmblemHealth seeks a Recovery Auditor to proactively assess vendor performance, monitor daily recovery activities, and engage with providers to recover overpayments. The role involves analyzing claims, eligibility, contracts, and reimbursement methods to identify recovery opportunities and improve accuracy.

The candidate should have 3–5+ years of healthcare recovery/auditing experience, expert knowledge of MSP/COB, and strong analytical and communication skills to collaborate across Claims,