Overpayment Recovery Analyst I or II DOE
Remote within: Washington, Oregon, Idaho and Utah
The Overpayment Recovery Analyst I or II DOE conducts comprehensive and thorough investigative research into complicated and specialized claims overpayment issues. Process a variety of claim types to support the research and identification of overpaid claims records and to apply refund receipts to correct members claims history. Performs in-depth research to validate overpayment scenarios received from members, providers and various third-party representatives communicated through email, fax, Customer Service tasks and check receipts. Reconciliation of vendor invoice activities. Initiate claims adjustments to recover overpayments from member and provider paid claims based on internal reports and vendor findings. Conducts analysis of findings and provides reports, feedback and recommendations to internal and external staff and management. Performs analysis involving external claims overpayment recovery requests, questions and disputes received through Customer Service tasks and correspondence. Create manual letters to members and providers in the Client Letter application.
General Functions and Outcomes
- Analyze data, claims processing and adjudication history, and make decisions to ensure accurate claims adjudication.
- Apply knowledge of medical terminology, ICD-10, CPT coding and other resources to resolve claim issues.
- Perform work in a clear and orderly way, including providing clear and concise audit trails for others to be able to follow the workflow
- Receives and responds quickly and effectively to calls received or placed to our members and/or providers.
- Process claims that are not eligible for auto processing. Handle adjustments generated by task notes or correspondence and corrected claims.
Normally to be proficient in the competencies listed above:
- Demonstrates the ability to apply critical thinking skills.
- Ability to provide excellent customer service to customers, providers and members and all levels of internal staff.
- Computer experience and familiarity with software, such as MS Word and Excel, or other compatible programs.
- Ability to work independently as well as a member of a team.
- Ability to work under pressure and meet deadlines. Must be highly adaptable and flexible with workload based upon the Team goals and priorities.
- Ability to communicate effectively orally and in writing. Ability to communicate claims overpayment information in writing when responding to internal external customers regarding issues/questions.
- Excellent interpersonal skills and the ability to work with all levels of staff.
- Ability to organize and prioritize workload and to meet deadlines.
- Demonstrate strong analytical ability in identifying problems and strong skills in performing in-depth investigation and judgement in developing solutions and implementing a course of action.
- Knowledge of medical terminology and ICD-10/CPT coding.
Overpayment Recovery Analyst I would have high school diploma or equivalent and 3 years office experience, to include 2 years of Regence claims experience or equivalent combination of education and experience.
#LIRemoteRequired Licenses, Certifications, Registration, Etc.
Optional - CPC CertificationWork Environment
Duties are performed in an at-home remote work environment.
Repetitive keying movements.
Sitting for extended periods of time processing claims overpayments.
The base pay annual salary range for Overpayment Recovery Analyst I $16.20-26.10/hour. For Overpayment Recovery Analyst II $16.20-28.15.The bonus target for this position is 5%.
At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the pay range.
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
- medical, dental, and vision coverage for employees and their eligible family members
- annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
- paid time off varying by role and tenure in addition to 10 company holidays
- up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
- up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
- one-time furniture and equipment allowance for employees working from home
- up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.