Accounting Clerk - Funds Recovery

The Funds Recovery Representative is responsible for handling all subrogation recoveries, Claims Audit Recoveries, Amounts paid for Retro-Termed Members and return payments. Also, when needed, will request refunds for claims payment corrections

Required:

1. Familiarity with medical terminology and medical claims, effective computer, analytical, organizational and customer skills; experience with computer spreadsheets and word processing
2. Excellent telephone skills

Desired:

1. Experience in account receivable collections preferred.

Responsibilities:

1. Identify Eligibility of HP members;
2. Log all calls on a Service Form in CSR Encounter Form;
3. Review and process various Reports (e.g. Retro-Termed Members, etc.)
4. Generate Letters to Members (mainly for Retro-Termed Members);
5. Send Refund Request Letters to Providers [e.g. Credit Balances Report, Dupe Reports];
6. Process Collection Notices toProviders;
7. Process and Submit Accident Reports to Subrogation Vendors
8. Process and Post Recoveries (Cash, Voids, Subrogation & Reinsurance);
9. Perform claim adjustments of Prior Payments
10. Balance Recoveries at the End of Each Month
11. Manage Calls from Members, Providers and Attorneys regarding Funds Recovery Issues
12. Run Required Reports
13. Post recoveries from Hospital & Facility Audits
14. Manage Hanging Credits and Associated Reports
15. Submit Monthly Totals and Reporting to Administration
16. Troubleshoot Issues with Vendors or Internal Processes
    
    Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.