Job Description
Pursue the recovery and allocation of overpaid dollars, and non-routine and complex refunds. Manage, monitor, and work overpayment items. Make outbound calls to providers; track and conduct follow-ups to recover funds.
Fundamental Components
Review, collect and resolve overpay or recovery conflicting, missing or inaccurate information via telephone or written correspondence with limited degree of supervision.
Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.
Process complex non-routine Provider Refund and Return Checks.
Review and interprets medical contract language using provider contracts to confirm whether or not a claim is overpaid in order to allocate refund checks.
Partner with internal customers/business units, third party vendors, and liaisons in order to recover and fully allocate refunds.
Administer overpayment recovery policy and procedures, telephone and written correspondence to members, providers and other insurers; includes development of systems reports.
Manage overpayment work, collaborate and conduct provider outreach to achieve business goals.
Use a systematic approach in solving problems through analysis and evaluation of alternate solutions.
Utilize available reports to track inventory and recovery results.
May deliver recovery training programs for less experienced team members.
Maintain and utilize all resource materials to manage job responsibilities.
Background Experience
Ability to interpret medical contract language.
Experience with claims adjustments.
2 - 4 years claims processing or customer service experience.
Independent decision-making skills.
Effective communications, organizational, and interpersonal skills.
High School Diploma, GED or equivalent experience
Additional Job Information
Effective communication skills, both verbal and written.Keyboard skills; certain tasks may require fluent PC skills.
Education
High School diploma, G.E.D. or equivalent experience
Percent of Travel Required
0 - 10%
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.