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Recovery Audit Analyst III - V...

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Job Summary

Company
Anthem
Location
Virginia Beach, VA
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4690

Recovery Audit Analyst III - Virginia Beach, VA (PS4690)

About the Job

Description
Your Talent. Our Vision. At Amerigroup, 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.

Preferred location - 1330 Amerigroup Way Virginia Beach, VA 23464.

May consider work at home or other Anthem locations.

Responsible for auditing and facilitating the recovery of claims overpayments as identified by our business partners. This person is responsible for research, analysis, documentation, outreach to providers, coordination of resolutions to overpayment issues, and recovery of identified overpayments.

PRIMARY RESPONSIBILITIES:
  • Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting or other research.
  • Performs collection activities to ensure the recovery of overpayments and negative balance accounts.
  • Works closely with contract managers to identify and correct contractual issues, when applicable.
  • Conducts complex case research and resolution for projects involving overpayments.
  • Interprets provider contracts as they relate to overpayment opportunities in compliance with Amerigroup, federal and state rules and regulations.
  • Ensures high customer satisfaction when acting as a liaison between department, health plans and high profile providers to resolve overpayment recoveries.
  • Assists in reviews of state complaints related to overpayments or negative balances.
  • Facilitates the resolution of state complaints within strict timelines established by the state.
  • Creates and interprets requirements and recommends methods to reduce overpayment errors.
  • Works with recovery and collection vendors to validate overpayments and vendor invoices.
  • Provides feedback to modify queries when needed.
  • Reviews department policy and procedure manuals for accuracy and completeness, and makes recommendations for improvement.
  • Performs claim and trend analysis, validation and recovery of claims payment errors.
  • Performs other duties as assigned.
Qualifications
Requirements
  • Bachelor's degree or equivalent combination of experience and education
  • Five years of cost containment experience

Preferred:
  • Prior Mentoring or coaching experience
  • Prior training and development experience
  • FACETS
  • Macess





Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and
is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit
us at antheminc.com/careers. EOE.M/F/Disability/Veteran
 

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