Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Financial Operations Recovery Specialist II - Virginia Beach, VA - Ps14494

Expired Job

Anthem, Inc. Norfolk , VA 23510

Posted 2 months ago

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Financial Operations Recovery Specialist II

Responsible for the discovery, validation, recovery, and adjustments of claims overpayments.

May do all or some of the following in relation to cash receipts, cash application, claim audits collections, overpayment vendor validation, and claim adjustments.

Primary duties may include, but are not limited to:

  • Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.

  • Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies.

  • Works closely with staff from other departments on a regular basis to ensure customer satisfaction.

  • Works closely with contract managers to identify and correct contractual issues when applicable.

  • May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.

  • Researches voluntary refunds for accuracy.

  • Requires accurate balancing of all accounts.

Qualifications:

  • Requires a H.S. diploma or equivalent;

  • 2-4 years of claims processing and/or customer service experience;

  • Or, any combination of education and experience, which would provide an equivalent background.

  • Associate degree or higher level degree preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Licensed Utilization Review II (Call Center Nurse) 1/28/19 Start Date Virginia Beach VA Ps13852

Anthem, Inc.

Posted 2 weeks ago

VIEW JOBS 11/30/2018 12:00:00 AM 2019-02-28T00:00 Your Talent. Our Vision. At Amerigroup, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. Nurses for this position must be comfortable working any eight hour shift Monday-Friday between 7am-7pm. The start date for these positions will be January 28th 2019. Licensed Utilization Review II (Call Center Nurse)-Medicare The Licensed Utilization Review Nurse is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. Examples of such functions may include: review of claim edits, pre-noted inpatient admissions or, episodic outpatient therapy such as physical therapy that is not associated with a continuum of care, radiology review, or other such review processes that require an understanding of terminology and disease processes and the application of clinical guidelines that require the use of critical thinking/nursing judgment. Primary duties may include, but are not limited to: * Conducts pre-certification, inpatient (if not associated with CM or DM triage) retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. * Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members. * Applies clinical knowledge to work with facilities and providers for care coordination. * May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process. * Educates the member about plan benefits and contracted physicians, facilities and healthcare providers. * Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications. * Facilitates accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards. * Requires an LPN, LVN, or RN; 2 years of acute care or utilization review experience; or any combination of education and experience, which would provide an equivalent background. * Current active unrestricted license in VA, or multi-state license in the state of residence if state is participatory in the nursing licensure compact. * Knowledge of the medical management process preferred. * Microsoft Office experience highly preferred. * Previous call center experience preferred. * Ability to obtain license in other states is required. Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. Equal Opportunity Employer/Disability/Veteran. Anthem, Inc. Norfolk VA

Financial Operations Recovery Specialist II - Virginia Beach, VA - Ps14494

Expired Job

Anthem, Inc.