Over Payment Recovery Specialist

Horizon Blue Cross Blue Shield of New Jersey, Hopewell, NJ, Openings : 1,
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Job Description : Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position is responsible for focusing on overpayment claimants activities and coordinating with care delivery related areas of the company. Assures overpayment claimants are address across the company and throughout the care delivery system. Responsibilities:
  • Identifying, validating, pursuing and recovering benefit claim overpayments.
  • Manage overpayment claimants within established customers.
  • Identify overpayment claimants within prospective customers.
  • Lead overpayment mitigation efforts to ensure overpayments are corrected.
  • Input overpayments in tracking system and adjusting claims as refunds are received.
  • Sending provider reversals for claim overpayments and tracking status.
  • Maintaining and investigating participants with terminated diagnoses related to services provided.
  • Processing requests for information and answering inquiries regarding overpayments of benefits from other departments, participants and providers.
  • Updating claims system notes and sending out requested forms, documents, claim details and other information as needed.
Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Education/Experience:
  • High School Diploma/GED required.
  • Minimum of four (4) years experience in an operational role, or analytical role.
Knowledge:
  • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Word/Excel/Access email application systems experience claims process and knowledge of FASCET is required.
  • Prefer knowledge of multiple lines of claim processing systems, including data entry pend resolution, adjustments and inquiry skills.
  • Proven ability to exercise sound judgment and strong creative problem solving. skills, along with the ability to identify continual improvement opportunities.
  • Must be detail oriented with strong follow-up skills.
  • Excellent verbal and written communication skills, including the ability to communicate with internal and external customers. Ability to represent the team in cross-functional meetings and workgroup sessions to identify improvement opportunities. Demonstrated ability to explain complex information.
  • Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
Skills &amp Abilities:
  • Requires excellent typing skills.
  • Requires excellent oral and written communication skills.
  • Requires excellent PC skills, particularly in MS Office (Excel, PowerPoint, Word).
  • Requires excellent organizational skills.
  • Requires excellent interpersonal skills.
  • Requires strong conflict resolution skills.
  • Requires the ability to effectively interact with all levels of the or
Salary Range: $68,500 – $91,665 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Last Date For Apply: 2024-06-12 00:00:00 Job Type : FULL_TIME, Employment Type : FULL_TIMEApply Here