Job Details

Requisition Number 18-0009
Post Date 1/22/2018
Title Recovery Specialist
City Austin
State TX

The Recovery Specialist I is responsible for entering, tracking, and resolving claims identified for recovery due to overpayment. This role works mainly with internal partners and focuses primarily on claims with low to medium complexity.


• Responsible for the entry, tracking, and resolution of claims identified for recovery due to overpayment.

• Responsible for the adjustments of professional and institutional claims that are identified as being overpaid.

• Communicate with team members of all changes or new interpretations of policies, problem identification and resolution, and implementation of new procedures.

• Identifies system problems and/or potential work flow issues; Informs Manager of issue(s) and potential solutions

• Researches and provides documentation to help resolve issues raised by administration and/or Providers in regards to adjustments and recoveries; Reviews with Manager

• Collaborates with internal departments and/or other unit Supervisors to develop processes to adjudicate claims accurately and timely

• Provides excellent customer service and human relations within the department as well as with other departments, providers, members and other external sources

• Builds and maintains collaborative relationships with organizational representatives and vendors, ensuring appropriate information transfer to accomplish business objectives

• Other duties as assigned




• High school diploma or equivalent

• Two or more years of claims processing or equivalent education/experience required

• Prior Medicare, HMO experience preferred

• Excellent proficiency in all technical applications related to claim processing including system workflow and design and benefit determination

• Knowledge of medical terminology, ICD-9/ICD-10 and CPT coding required.

• Competent in MS office and PC skills preferred

• Working knowledge of COB required

• Ability to demonstrate organizational, interpersonal, and communication skills

FirstCare Health Plans is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetics or any other basis prohibited by law.

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