Adept Cost Recovery Specialist with a proven track record at Government Employees Health Association Inc, excelling in asset recovery and employing advanced collection techniques. Demonstrated expertise in handling complex overpayment cases, ensuring accurate documentation and effective coordination with external vendors. Skilled in investigative tools and payment processing, consistently achieving significant recovery outcomes.
Reviews and audits overpayments received from the Claims department, and reviews possible overpayments involving other coverage and/or workers' compensation to determine the extent of overpayments. • Researches and reviews member/provider disputes of overpayments. Prepares written responses, responds to telephone inquiries, and makes outgoing calls to and from members and providers. Reviews and coordinates overpayments and collections efforts with outside collection vendors, and makes determinations in accordance with overpayment guidelines. • Adjusts claims and posts refund checks received related to overpayments. Documents appropriate actions in claims processing systems and Macess various databases. Researches and responds to correspondence received related to overpayments from members and/or providers. • Manages and completes the departments workloads (WC/MC/OC/Checks Backlog). • Balances refunds from vendors, ensures correct fees have been applied and submits to Accounting for vendor payment. • Audit overpaid claims created in Facets for accuracy to confirm the debt does exist and is in the appropriate amount. • Send overpayment letters to members or providers to attempt recovery of overpaid amounts on claims and RX purchases. • Send PMCS overpaid claims to PMCS to coordinate the collection of providers' payments and PMCS fees. • Make calls to members and providers on overpayments equal to or over $1,000 and request additional information when needed. • Fax letters to providers. • Take incoming calls related to open overpayments or offset overpayments. • Work follow-up reports for overpayments that need additional action. • Review the Line of Determination for Medicare and Other Coverage and contact enrollment when necessary. • Respond to incoming correspondence related to open overpayment issues. • Work refund and returned checks including adjusting claims in Facets • Research unidentified Refunds • Update Appeal records to document overpayment pursuit • Review overpayments over 120 days old to determine next step • Coordinate collection efforts with outside collection vendors • Manage Auto Recovery of overpayments including timely communication with provider and detail documentation
Earned the MS Spirit award in 2019 from the local MS Society.