Address
Form of workJOB DESCRIPTION
JOB SUMMARY (Purpose of the Job & high-level summary):
Responsible for reviewing Medicaid, Medicare and Marketplace claims for overpayments; Researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Posting of provider refund, offsetting of claims, Requesting Provider AP checks, Reconciling monthly bank deposits. Also responsible for verbally interacting with health plans and vendors regarding recovery outstanding overpayments.
Working knowledge of claims payments, multiple State billing guidelines and claims processing policies and procedures.
JOB DUTIES (Main duties & responsibilities of the role):
Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments.
Maintains and reconciles department reports for outstanding payments uncollectible claims, and auto-payment recoveries.
Prepares and provides write-off documents that are deemed uncollectible or collections efforts are exhausted for write off approval.
Research simple to complex claims payment including researching tools such as DSHS and Medicare billing guidelines, Molina claims’ processing policies and procedures and other such resources to validate overpayments made to providers
Complete basic validation prior to offset to include, but are not limited to, eligbility, COB, SOC, and DRG requests.
Enter and update recovery in Recovery applications and claim systems for multiple states prepare and create overpayment notification letters with accuracy. Process claims as a refund or auto debit in claim systems and in Recovery application meeting expected production and quality expectations.
Quality includes following department processing policies and correctness in perform the department duties including but not limited to; claim processing (claim reversals and adjustments), claim recovery (refund request letter, refunds checks, claims reversals), reporting and documentation of recovery as explained in department Standard Operating Procedures.
Consistently meet work standards related to job functions.
Effectively Communicate with all employees of Molina regarding all aspects of recovery, claim payment, provider remittances and general recovery processes.
Respond to provider correspondence related to recovery requests and provider remittances where recovery has occurred.
Work closely with Finance departments to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse provider.
Other duties as assigned.
Complies with workplace safety standards.
REQUIRED EDUCATION :
Require High School Diploma or equivalent
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :
1-3+ years’ experience in claims adjudication, Claims Examiner II or other relevant work experience
Recovery Experience preferred
Minimum 1 + year experience in customer service
Minimum 1+ year experience in Healthcare Insurance environment with Medicaid, and Managed Care experience
Strong technical skills with Excel and Word
Strong verbal and written communication skills
Ability to work with multiple systems
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :
Licensure/Certification: None required
PREFERRED EDUCATION :
Associate’s Degree or equivalent combination of education and experience
Some college preferred in related areas
PREFERRED EXPERIENCE :
Recovery Experience preferred
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :
Licensure/Certification: None required
STATE SPECIFIC REQUIREMENTS :
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $13.41 - $29.06 / HOURLY
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
