Opportunity Description
Schedule: Hybrid schedule - remote work on Monday and Friday, and onsite presence Tuesday through Thursday.
Description:
The Provider Recovery Auditor is responsible for auditing and recovering claims overpayments, including the coordination of benefits (COB) and third-party liability. This role supports organizational quality initiatives and ensures compliance with claims processing guidelines, contractual agreements, and regulatory standards within a managed care environment.
Description:
The Provider Recovery Auditor is responsible for auditing and recovering claims overpayments, including the coordination of benefits (COB) and third-party liability. This role supports organizational quality initiatives and ensures compliance with claims processing guidelines, contractual agreements, and regulatory standards within a managed care environment.
What You Will Do:
- Identify and expand recovery opportunities through audit findings, provider outreach, third-party liability, and CCS eligible services
- Conduct audits of payment errors and process provider refund checks while determining root cause
- Review claims processing outcomes to ensure accuracy and proper a...
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