What are the responsibilities and job description for the Recovery Analyst I position at CenCal Health?
Central Coast Salary Range: $23.30 - $32.62
Job Summary
While candidates from anywhere are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
This position is responsible for maintaining and coordinating Medicare recoveries, Other Health Coverage (OHC) cost avoidance-coding corrections/updates, assisting agency staff with Medicare and Recovery related inquiries, participating in audits as required, and assisting with maintaining currently established recovery programs and projects as assigned.
Duties & Responsibilities
- Assist in preparation of weekly deposit as necessary
- Participate in DMHC, DHCS and Finance audits as required
- Perform Other Health Coverage (OHC) Code changes/corrections
- Maintain the Retro-Medicare Recovery Billing program
- Maintain the paper and electronic correspondence files
- Maintain accurate and accessible billing and financial reporting records and files, including reconciliation of payments, and coding updates/corrections
- Assist with Medicare updates, as necessary
- Research and adjust claims as needed for the Voluntary Repayment checks
- Update coding and/or enter notes to system for cost avoidance
- Submit request for updates of OHC coding to DHCS
- Maintain accurate and current reporting files for code updates/corrections
- Bill other health coverage carriers
- Research, assist, and attempt to resolve OHC billing inquires or concerns
- Report billing concerns to Recoveries Manager and/or Recoveries Coordinator
- Assist with Medicare updates when possible
- Deposit check through remote deposit system or manually
- Reconcile checks to be deposited and all commercial credit card statements
- Submit Tort documents to DHCS to comply with contract agreement
- Monitor and bill provider overpayments (negative EOBs)
- Assist in resolving inquiries or concerns when necessary
- Contact vendors as needed
- Other duties as assigned
Knowledge/Skills/Abilities
- Knowledge of health insurance plans; Medi-Cal and Medicare
- Knowledge of Medi-Cal regulations
- Knowledge of Claim procedures
- Third party recoveries and coordination of benefit policies
- Experience in claims processing and/or preparation
- Accurate reporting, record keeping and bookkeeping
- Good oral, written and interpersonal communication skills
- Detail oriented
- Ability to operate effectively under pressure
- Knowledge in operating general office equipment (computer, calculator, copy and fax machines)
- Maintain confidentiality
Education & Experience
Required:
- High school diploma or equivalent
- Minimum two (2) years office experience
- Minimum two (2) years Claims processing/billing/coding experience
- Successfully pass a background credit check
Salary : $23 - $33
