Provider Recovery Auditor

Provider Recovery Auditor

Job Description

Position Summary/Position
Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.

Major Functions (Duties and Responsibilities)
1. Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
2. Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
4. Promote teamwork and maintain effective working relationships with others throughout the organization.

Qualifications

Education & Experience
Four (4) years claims processing experience including Medicare and Medi-Cal
Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
Experience with MS Office applications

Key Qualifications
Strong analytical and problem-solving skills
Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
Microsoft Office including being able to manipulate large data sets in Excel files
Excellent oral and written communication skills

Notes:
Hybrid

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.