Claims Recovery Auditor in Newark, NJ at Beacon Health Options

Date Posted: 6/27/2018

Job Snapshot

Job Description


We are currently seeking dynamic Claims Recovery Auditors to join our team in Newark, NJ.  The Claims Recovery Auditors ensure payment resolution for identified claim overpayment recoveries in a timely, accurate, and efficient manner

Position Responsibilities may include:

  • Provide resolution to identified overpayments through claim adjustments, Accounts Receivable tracking (AR), managing complex and escalated inbound calls related to overpayment activities,
  • Review and audit claims data to identify overpayments using defined business rules and workflow instructions including authorization (including but not limited to authorization reviews, benefit inquiries, and on-line desk levels)
  • Adjust claims (i.e. product benefit design, clinical policies, business rules, and authorizations) in accordance with vendor contract provisions and all other governing policies and/or procedures
  • Document and track accounts receivable activities in all related systems (i.e. database tracking, inquiry tracking, and etc.)
  • Research and resolve Accounts Receivable (AR) issues triaged from Operations including the submission of electronic briefs, reviewing historical claim activity, validating offset status in the Universal Payment System (UPS), and partnering with Operations departments
  • Coordinate with other Operations departments and external entities (i.e. Department of Banking and Insurance, Executive Complaints and Appeals, or State regulatory agencies) to address customers' inquiries regarding  recovery activities for claim overpayments
  • Ensure accurate and timely resolution of service requests and activities to assist Complaints and Appeals with resolution of written correspondence or telephone escalations in accordance with the customer's health benefit coverage and company policies
  • Follow up on unresolved issues via outbound calls, emails or faxes
  • Share knowledge and information willingly with team members to achieve team, division, and enterprise goals, service quality, and client satisfaction
  • Effectively communicate with the client in manner that demonstrates professionalism and excellent service.
  • Submit provider file updates and any system maintenance requests that impact claims payment activities
  • Train, mentor, and provide assistance for new hires
  • Generate monthly client reports to track and share AR activities as assigned by management
  • Act as an inter-departmental liaison for inquiries related to overpayment recovery operations
  • Identify and document process improvement activities to improve team efficiency and reduce future overpayments
  • Complete ad hoc requests or projects as assigned by management
  • Perform other related tasks as assigned by management

Position Requirements:

  • Education - High School Diploma or equivalent required. Some College preferred
  • Licensure:  not required

Relevant Work Experience:

  • 3-4 years of NASCO claims processing experience preferred
  • 1-2 years of accounts receivable experience preferred
  • Advanced proficiency with PC applications such as Excel and Access
  • Experience with systems applications: UCSW, NASCO, and UPS
  • Strong knowledge of medical terminology preferred, analytical thinking, strong written & verbal communication necessary

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disable