Claims Receivables and Recovery Specialist
WESTERN GROWERS GROUP —Fresno, CA
- $46,669.19 - $60,668.60 a year
- Full-time
- Remote
- Writing skills
- HIPAA
- Research
- Dental insurance
Quick Apply
2d
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INNOVATIVE INTEGRATED HEALTH —Fresno, CA
- $19 - $23 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health savings account
- Health insurance
1d
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Sante Health —Fresno, CA
- $17 - $24 an hour
- Full-time
- High school diploma or GED
- 1 year
- Medical terminology
- Health insurance
- Dental insurance
Quick Apply
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Part D Administrator
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- $75,000 - $90,000 a year
- Full-time
- Microsoft Outlook
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Sante Health —Fresno, CA
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- Full-time
- Spanish
- Surgery
- Mid-level
- Health insurance
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Medical Operations Coordinator (CVWHA)
Sante Health —Fresno, CA
- $22 - $26 an hour
- Full-time
- Customer service
- Computer literacy
- Writing skills
- Health insurance
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Office Manager (AGHA)
Sante Health —Fresno, CA
- $33.79 - $37.00 an hour
- Full-time
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Quick Apply
Guest Services Representative
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- Full-time
- Microsoft Outlook
- Writing skills
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Quick Apply
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- Full-time
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Quick Apply
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12d
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Claims Receivables and Recovery Specialist

WESTERN GROWERS GROUP
Fresno, CA

Quick Apply

Job Details

Full-time
$46,669.19 - $60,668.60 a year
2 days ago

Benefits

Dental insurance

Qualifications

Medical claims processing
Spreadsheets
Writing skills
Dental insurance
ICD-10
CPT coding
Productivity software
Financial data analysis tools
Data analysis software

Full Job Description

Job Description Summary

The Claims Receivables and Recovery Specialist reports to the Supervisor, Payment Integrity, and works with various departments within the company to ensure all open claim receivables, which are results of claim overpayments and/or adjustments, are pursued and collected appropriately. The position is responsible for appropriate approvals, presentations of the receivables for decisions, and process documentation.

Duties And Responsibilities

Receivable & Recovery Support

Research, review and analyze all overpayments, refunds and voids relating to medical, dental, and vision claims.
Collect receivables for the Western Growers Assurance Trust (WGAT) and clients of the Third-Party Administrator (TPA) that may be a result of overpayments or claims adjustments by researching, writing letters, and actively making phone calls.
Process refunds and perform voids and reissues as deemed necessary.
Review, research and analyze statistical data relating to claim history.
Research and respond to inquiries from other departments related to claim financial transactions within the required agreed upon turn-around-time.

Reporting

Run claim open receivables report to review for new and past due overpayments.
Prepare a monthly report to the management team which provides consistent activity, tracking and performance measures as a result of collections, overpayments, refunds, voids, and allocation of all monies received.
Prepare reports for accounting to handle processing, approvals for adjustments, void, refunds.
Assure all documentation is categorized, approvals file and archived upon demand.
Support, analyze and prepare for auditors and the requested information on a timely manner.
Prepare presentations of data, clients files, and analysis to obtain approvals to adjust overpayments accordingly.

Process Improvement

Identify and document root causes of claim overpayments.
Provide claim overpayment remediation recommendations.
Participate in ongoing process reviews to eliminate and/or decrease open receivables.

Other

Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

Qualifications

High school education or equivalent and two (2) years of experience adjudicating medical/dental claims and handling claims recoveries.
One (1) year of collections experience preferred.
Accounting or Receivables background preferred.
Knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases 10th Revision (ICD-10) and medical terminology.
Exceptional knowledge of end-user office software (e.g., Microsoft Office), with particular emphasis on Excel spreadsheets and summary analysis.
Exceptional understanding and interpretation of financial transaction and receivables systems.
Proven ability to manage timelines and commitments independently.
Excellent verbal and written communication skills.
Ability to apply critical thinking and demonstrate sound judgement in a variety of situations.
Strong attention to detail.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
A functioning smoke detector, fire extinguisher, and first aid kit on site.

Quick Apply

Refine Your Search

medical claims processing jobs in fresno ca

Claims Receivables and Recovery Specialist

Claims Customer Service Representative

Front Office Scheduler (CVWHA)

Eligibility Specialist

Medical Assistant, Outpatient - Clinic Overhead - Call Center (Full-Time, Day Shift)

Part D Administrator

Managed Care Claims Assistant I

Surgery Scheduler & Authorization Coordinator (AGHA)

Medical Operations Coordinator (CVWHA)

Office Manager (AGHA)

Guest Services Representative

BILLING/FINANCIAL COORDINATORS

Medical Assistant (CVWHA)

Medical Assistant - Back Office (NWMG)

Pharmacy Technician

Medical Assistant Front/Back (AGHA)

Medical Assistant/Receptionist

Medical Coder

Registered Nurse (RN) (UGSC)

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