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Funds Recovery

The Health Plan of West Virginia Inc Wheeling, WV

  • Posted: over a month ago
  • Full-Time
Job Description

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. 

Requirements:

  1. Familiarity with medical terminology and medical claims, effective computer, analytical, organizational and customer skills; experience with computer spreadsheets and word processing.
  2. Excellent telephone skills.
  3. Ability to multi-task.

Desired:

  • Experience in accounts receivable collections.

Responsibilities:

  • 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

Address

Wheeling, WV
26003 USA

Industry

Finance and Insurance

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