Responsible for setting up and adjusting claims overpayments that have been previously identified. 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: Reviews and validates paid claims for overpayments using various techniques including system-based queries, specialized reporting, or other research. Determines and calculates amount of overpayments and processes refunds. Researches voluntary refunds for accuracy. Requires accurate balancing of all accounts. Responsible for more routine issues. May work with internal staff from other departments to ensure customer satisfaction. May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable balances and all other cash applications. Requires a H.S. diploma; 1-2 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background. Associate degree preferred.
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