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Cost Recovery Manager

Posted: 09/11/2022

Position Title: Manager – Cost Recovery
Open Positions: 1
Posted Date: September 9, 2022
Location: Missouri-Remote
Department: Cost Recovery
Supervisor: Robin Darden
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Summary Reporting within the Member Operations department, this Manager role will oversee the programs to recover cost of claims and other payments to ensure that payments are aligned with member risk profile, accounts are managed appropriately to minimize write-offs, and ensure timely processing of payments to manage overdue accounts and optimize cash flow. This position will be tasked to create and implement effective and efficient credit and collections processes. The Manager will design and implement processes to improve cash flow, monitors operations, and negotiation the collection of overdue accounts.
Duties • Manages cost recovery operations for company so as to maximize collection efforts and reduce outstanding overpayments. Reviews collection activity reports, reports on total overpayments and collections. Monitors trends for causes of overpayments and manages Cost Recovery Friendly Reminder program. Coordinates collection of PPO overpayments with GEHA's PPO Operations Department and PPO vendors. • Reports overpayment error trends to the Chief Operating Officer, Vice President, Health Plan Business Operations; Director, Health Plan Business Operations, Claims Managers and Internal Audit Manager in an effort to reduce future overpayments. May report overpayment data for use in internal financial or procedural audits or in external audits such as those conducted by the Office of the Inspector General. • Recommends enhancements in cost recovery procedures to Director, Health Plan Business Operations. • Coordinates collection efforts with collection vendors and PPO Department and vendors. Manages complex collection issues, conferring with members, providers, and attorneys. Negotiates settlement of unusual collection issues. • Reviews unresolved overpayments and makes determination in accordance with overpayment guidelines. Consults with legal and other experts to resolve unusual recovery situations; recommends resolution of highly unusual recovery situations to Director, Health Plan Business Operations. • Manages provider overpayment offset function; analyzes and reports to Director, Health Plan Business Operations, regarding collection results. Reviews and approves procedural changes; recommends program improvements to Claims. Consults with Director, Health Plan Business Operations about legal issues regarding overpayment offsets. • Manages department operations. Approves training and development of employees. Meets with supervisor and staff to communicate changes. Reviews and approves performance evaluations for Cost Recovery staff, prepares performance evaluations for supervisor, and conducts performance evaluation meetings. Evaluates department performance and implements corrective action. • Analyzes department turnaround time ("TAT") and production statistics. Initiates changes in workflow needed to ensure department objectives are met. • Other duties as assigned.
Government Employees Health Association, Inc.
Education Requirements Requires a bachelor’s degree.
Experience Requirements • Additional relevant experience may be considered in lieu of education • Requires six years of experience in healthcare, payment collections, or operations. • Requires three years supervisory experience • Requires knowledge of MS Word and MS Excel. • Requires demonstrated analytic ability and highly effective verbal and written communication skills to develop or approve written materials, explain complex overpayment situations, and provide instructions. • Requires demonstrated ability to negotiate business agreements. • Requires a proven record of meeting commitments and achieving goals through the encouragement, guidance and influencing of others. • Requires a self-starter.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.

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