Financial Operations Recovery Specialist I-III- Any Anthem Location or WAH- PS26496

Financial Operations Recovery Specialist I-III- Any Anthem Location or WAH- PS26496

30 Aug 2024
Georgia, Augusta 00000 Augusta USA

Financial Operations Recovery Specialist I-III- Any Anthem Location or WAH- PS26496

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Financial Operations Recovery Specialist I-III- Any Anthem Location or WAH- PS26496Location: United StatesNewRequisition #: PS26496Financial Operations Recovery Specialist I-III- Any Anthem Location or WAHWellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and theopportunity to take your career further than you can imagine.There are 21 positions available in the following locations: Any Anthem Location or WAH-May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments.-Responsible for the discovery, validation, recovery, and adjustments of claims overpayments.Primary duties may include, but are not limited to:Level I-Reviews and validates paid claims for overpayments using various techniques including system-based queries, specialized reporting, or other research.-Determines and calculates amount of overpayments and processes refunds.-Researches voluntary refunds for accuracy.-Requires accurate balancing of all accounts.-Responsible for more routine issues.-May work with internal staff from other departments to ensure customer satisfaction.-May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable balances and all other cash applications.Level II-Responsibilities of Level I-Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.-Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies.-Works closely with staff from other departments on a regular basis to ensure customer satisfaction.-Works closely with contract managers to identify and correct contractual issues when applicable.-May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.-Researches voluntary refunds for accuracy.-Requires accurate balancing of all accounts.Level III-Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.-Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction.-May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.-Works closely with contract managers to identify and correct contractual issues, if applicable.-Handles complex case research and resolution.-May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.-May review and monitor associates work for quality standards.-May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete.-Assists in special projects to find and prevent overpayments and to identify process improvements.-Completes special projects as assigned with minimal supervision.-Researches voluntary refunds for accuracy.LEVEL I-Requires a H.S. diploma.-1-2 years of WGS claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.-Associate degree preferred.-Current working knowledge using WGS required.-WGS professional and facility claims processing/adjustment experience is required.-Pricing system knowledge with WGS Stand Alone, ETS Networx Pricer/GA Pricing System, Price N Ship/ Central Networx Pricing, OHAS preferred.LEVEL II-Requires a H.S. diploma.-2-4 years of WGS claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.-Associate degree or higher level degree preferred.-Current working knowledge using WGS required.-WGS professional and facility claims processing/adjustment experience is required.-ACR experience is preferred.-Pricing system knowledge with WGS Stand Alone, ETS Networx, Pricer/GA Pricing System, Price N Ship/ Central Networx Pricing, OHAS required.LEVEL III-Requires a H.S. diploma;-4-5 years of WGS claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.-Requires accurate balancing of all accounts.-Associate degree or higher level degree preferred.-WGS claims processing and adjustment experience required.-Claims Overpayment Recovery (COR), Anthem Claims Recovery (ACR) and Coordination of Benefits (COB) experience preferred.-Pricing system knowledge with WGS Stand Alone, ETS Networx, Pricer/GA Pricing System, Price N Ship/ Central Networx Pricing, OHAS required.WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, andis a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us atwww.wellpoint.com/careers. EOE

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Job Details

  • ID
    JC2668080
  • State
  • City
  • Full-time
  • Salary
    N/A
  • Hiring Company
    Anthem
  • Date
    2019-08-31
  • Deadline
    2019-10-30
  • Category

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