Recovery Specialist

Recovery Specialist

Who is Intellivo?  

Powered by IntellivoIQ technology, we provide solutions to health providers and billers and for health plans and administrators by identifying previously undetected complex third-party liability (TPL) claims and increase the number of recovery opportunities resulting in higher reimbursements from TPL sources.   

Imagine a place where your talent is treasured, and excellence is rewarded. Now imagine a collaborative culture where every voice is valued. And a team united by solving some of the most complex challenges on the financial side of healthcare.  

We are Intellivators – forward-thinking pioneers building the technologies that Fortune 500 employers, health plans, TPAs, providers, and billing organizations rely on to ensure responsible claim payments. Fueled by our experience and innovative startup mentality, we’re growing fast.  

Role Summary

As the Recovery Specialist, you will be responsible for investigating, recovering, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. This includes making telephone calls to members, providers, and other insurance companies to gather coordination of benefits data. You will be key in investigating and pursuing recoveries and payables on subrogation claims and file management while ensuring adherence to state and federal compliance policies, reimbursement policies and contract compliance. May also conduct contestable investigations to review medical history.

Location 

This role is an on-site position in St. Louis, MO. 

Responsibilities 

• Obtain all available data relevant to investigation/overpayment identifications
• Conduct/utilize investigations/overpayment identifications to determine accuracy of claims payments (prospectively and retrospectively)
• Analyze contractual requirements to determine if funds are owed to payers
• Perform research/verification of identified claims to identify payment/overpayment issues/accuracy
• Complete file set up on subrogation/workers' compensation cases
• Work with payers/providers to review claim information and identify issues related to payment accuracy
• Update applicable claims systems to ensure that claims payments reflect accurate payment levels and appropriate payers (COB, primary vs. secondary payers)
• Document and communicate outcomes of claims investigations/overpayment reviews to applicable stakeholders
• Negotiate recovery amounts with applicable stakeholders (e.g., attorneys, other insurance carriers, members, providers)
• Communicate overpayment information to payers/providers as appropriate, including explanations of the reasons for overpayment (e.g., inbound/outbound calls, letters, emails)
• Drive resolution of overpayments based on relevant claims information, policies, and regulations
• Develop and maintain relationships with applicable external stakeholders (e.g., members, providers, commercial clients, government/regulatory agencies, vendors)
• Manage, document and prioritize case load - individual and department (e.g., TAT, schedule adherence)
• Report and monitor overpayment identifications and resolutions in order to establish and measure progress against targets and objectives
• Identify, implement, and report opportunities to improve processes, procedures, systems, and/or organizational structures (e.g., to drive improved quality/ efficiency, strengthen stakeholder relationships)
• Demonstrate understanding of applicable federal, state, and local compliance regulations (e.g., DOI, DOL, Healthcare Reform/PPACA, CMS)

Qualifications 

• High school diploma or equivalent required
• Strong working knowledge of MS Office & MS Outlook
• Driven and outgoing personality
• Excellent communicate skills (written & verbal)
• Well organized, detail oriented and flexible
  
  

Why work for Intellivo? 

• Amazing Team Members – Intellivators!
• Medical Insurance
• Dental & Vision Insurance
• Industry leading health & wellness benefits
• 401(K) retirement plan
• Generous Paid Time Off
• And More!

*Benefit Recovery Group has been renamed Intellivo.