Recovery Analyst
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Job Description
Recovery Analyst managing subrogation cases and NSA disputes for affordable healthcare at Centivo. Fostering relationships with internal/external customers while ensuring compliance with regulations.
Responsibilities:
- Prepare documentation, review claim history, and other documentation related to overpayment, subrogation, and NSA requests.
- Utilize available resources to investigate claim situations for overpayment, subrogation, and NSA cases.
- Follow-up with responsible departments and delegated entities to ensure compliance.
- Monitors daily and weekly inventory to ensure internal and regulatory timeframes are met.
- Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, network contracting, policies and procedures, administrative costs, cost-saving opportunities, best practices, and performance issues.
- Notifies the assigned vendors and clients of the subrogation and recovery interest; confers with other parties, internal departments, and clients concerning potential settlement or other actions.
- Represents Centivo in meetings concerning recovery, subrogation, and NSA matters, including facilitating calls between Centivo’s third-party vendor and the client, to obtain final approval.
- Maintain data entry requirements for all complaints and appeals.
- Perform any other additional tasks or duties as assigned or required.
Requirements:
- High School diploma or equivalent required, Associate degree preferred.
- At least one year of experience in health plan operations, claims processing, or other experience directly related to position duties and knowledge.
- At least one year of experience in NSA requests and subrogation.
- Additional years of experience/training may be considered in lieu of educational requirements required.
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
- Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment.
- Knowledge of applicable rules and statutes, of the process and principles of insurance and of basic subrogation and NSA concepts.
- Ability to comprehend and produce grammatically accurate, error-free business correspondence required.
- Ability to appropriately identify urgent situations and follow the appropriate protocol.
- Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment.
Benefits:
- Offers Equity
- Offers Bonus
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