Claims Recovery Examiner

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $22 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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All Care To You

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

💼 Consulting

Healthcare • Healthcare Insurance • Consulting

All Care To You is a Management Service Organization (MSO) dedicated to fostering a collaborative work environment grounded in knowledge, trust, growth, and respect. The company primarily operates within the hospitals and healthcare sector, offering a range of services that support healthcare providers and enhance patient care.

📋 Description

• Comply with all Company and Department Policies and Procedures • Assist in claims audit activities when needed • Review incoming recovery checks, close paid recoveries, and follow up with providers regarding outstanding recoveries • Assist the Finance team with matching bank transactions and bank reconciliations • Process and post daily refund checks • Prepare weekly and monthly reports to management regarding refund requests and refunds received • Prepare monthly reconciled reports of refund checks with Accounts Receivables for management and IPA analysts • Review refund requests for correct amount and reason • Extract and report claim information for data tracking • Prepare and mail refund request letters to providers • Update claim notes and documentation with refund requests and refunds received information • Review, report, and re-request letters of overpayment sent out 30 or more days • Investigate and follow up on claims issues regarding overpayments • Verify providers’ pending claims for recoupment by offset • Recover money owed by providers on claims by offset • Investigate and follow up on provider requests • Coordinate daily with claims, finance, IT, provider network, eligibility, and other departments • Facilitate calls as needed to verify or research claims refund information • Resolve claims issues involving processing errors and recommend improvements to avoid errors • Support claims team members with other duties upon request • Support other departments as needed • Perform all other duties as assigned

🎯 Requirements

• Five years’ experience processing Commercial, Medi-Cal and/or Medicare or other government agency claims • Service/Diagnosis coding experience • Knowledge of claims rules and regulation turnaround timeframes by line of business • Ez-Cap experience preferred • Proficient with all Federal and state requirements in claim processing • Knowledge of medical terminology and coding • Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel), and Adobe • Detail oriented and highly organized • Strong ability to multi-task, project management, and work in a fast-paced environment • Strong ability in problem-solving • Ability to self-manage and strong time management skills • Ability to work in an extremely confidential environment • Strong written and verbal communication skills

🏖️ Benefits

• Fully remote work environment • Flexible work environment and schedules • 100% employer-paid medical coverage • 100% employer-paid vision coverage • 100% employer-paid dental coverage • 100% employer-paid life coverage • Paid holidays • Paid sick time • Paid vacation time • 401(k) plan • Additional employee-paid coverage options