The Health Plan of West Virginia Inc Wheeling, WV
- Posted: over a month ago
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.
- 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.
- Experience in accounts receivable collections.
- Identify Eligibility of HP members;
- Log all calls on a Service Form in EXP;
- 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 Print Que, Dupe Reports];
- Process Collection Notices to Members/Providers;
- Process and Submit Accident Reports to Subrogation Vendors;
- Process and Post Recoveries (Cash, Voids, Subrogation & Reinsurance);
- Perform Take-Backs 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.
The Health Plan of West Virginia Inc
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