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Cost Recovery Specialist

Posted: 09/09/2022

Position Title: Cost Recovery Specialist
Open Positions: 1
Posted Date: September 9, 2022
Location: Independence, MO (Landmark Building)
Department: Cost Recovery
Supervisor: Robin Darden
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Summary Analyze and review overpayments and collections of healthcare cost claims. Coordinate collection efforts with external vendors and agencies. Under general supervision, this role will review, evaluate, document, report, and communicate cost and payment status of member claims.
Duties • Reviews and audits overpayments received from the Claims department and reviews possible overpayments involving other coverage and/or workmen’s compensation to determine extent of overpayments. • Research and reviews member/provider disputes of overpayments. • Prepares written response and responds to telephone inquiries and makes outgoing calls to/from members and providers. • Reviews and coordinates overpayments and collections efforts with outside collection vendors and makes determination in accordance with overpayment guidelines. • Adjusts claims and posts refund checks received related to overpayments. • Documents appropriate actions in claims processing systems and various databases. • Researches and responds to correspondence received related to overpayments from members and/or providers. • Manages and completes the departments workloads (WC/MC/OC/Checks Backlog). • Balances refunds from vendors, ensures correct fees have been applied and submits to accounting department for vendor payment.
Education Requirements Requires High School diploma or equivalent.
Experience Requirements • Requires 2 years of claims knowledge. • Requires effective written and verbal communications to explain obligations and negotiate recoveries. • Performs other duties as assigned.
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.
Government Employees Health Association, Inc.
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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