200+ applicantsPosted by Agency

Company

Molina Healthcare · 6 hours ago

Specialist, Claims Recovery

Arizona, United States

Full-time

Remote

Entry Level

$20.29/hr - $34.88/hr

1+ years exp

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Responsibilities

Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments.

Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims, and auto-payment recoveries.

Prepares and provides write-off documents that are deemed uncollectible or collections efforts are exhausted for write off approval.

Researches simple to complex claims payments using tools such as DSHS and Medicare billing guidelines, Molina claims’ processing policies and procedures, and other such resources to validate overpayments made to providers.

Completes basic validation prior to offset to include, but not limited to, eligibility, COB, SOC and DRG requests.

Enters and updates recovery in recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy. Processes claims as a refund or auto debit in claim systems and in recovery application meeting expected production and quality expectations.

Follows department processing policies and correctness in performing departmental duties, including but not limited to, claim processing (claim reversals and adjustments), claim recovery (refund request letter, refund checks, claim reversals), reporting and documentation of recovery as explained in departmental Standard Operating Procedures.

Responds to provider correspondence related to recovery requests and provider remittances where recovery has occurred.

Works with Finance to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse providers.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims AdjudicationHealthcare InsuranceMedicaidMicrosoft OfficeRecovery ExperienceExcelWord

Required

HS Diploma or GED

1-3 years’ experience in claims adjudication, Claims Examiner II, or other relevant work experience

Minimum of 1 year experience in customer service

Minimum of 1 year experience in healthcare insurance environment with Medicaid, or Managed Care

Strong verbal and written communication skills

Proficient with Microsoft Office including Word and Excel

Preferred

Associate’s Degree or equivalent combination of education and experience

Recovery experience preferred

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10,001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)