The Health Plan - Wheeling, WV
posted 4 days ago
Wheeling, WV
Ambulatory Health Care Services
About the position
The Funds Recovery Representative is responsible for handling all subrogation recoveries, Claims Audit Recoveries, Amounts paid for Retro-Termed Members and return payments. Also, when needed, will request refunds for claims payment corrections.
Responsibilities
- Identify Eligibility of HP members
- Log all calls on a Service Form in CSR Encounter Form
- Review and process various Reports (e.g. Retro-Termed Members, etc.)
- Generate Letters to Members (mainly for Retro-Termed Members)
- Send Refund Request Letters to Providers [e.g. Credit Balances Report, Dupe Reports]
- Process Collection Notices to Providers
- Process and Submit Accident Reports to Subrogation Vendors
- Process and Post Recoveries (Cash, Voids, Subrogation & Reinsurance)
- Perform claim adjustments of Prior Payments
- Balance Recoveries at the End of Each Month
- Manage Calls from Members, Providers and Attorneys regarding Funds Recovery Issues
- Run Required Reports
- Post recoveries from Hospital & Facility Audits
- Manage Hanging Credits and Associated Reports
- Submit Monthly Totals and Reporting to Administration
- Troubleshoot Issues with Vendors or Internal Processes
Requirements
- Familiarity with medical terminology and medical claims
- Effective computer, analytical, organizational and customer skills
- Experience with computer spreadsheets and word processing
- Excellent telephone skills
- Ability to multi-task
Nice-to-haves
- Experience in accounts receivable collections
