Cotiviti

Recovery Resolution Specialist*

Job Locations US-Remote
ID 2023-9678
Category
Customer Service/Retrieval Operations
Position Type
Full-Time

Overview

The Recovery Operations Team under Cotiviti’s Yield Management business unit to provide maximum savings for Cotiviti’s client. The Recovery Team facilitates the recovery of funds through building and maintaining relationships with healthcare providers and partnering with Cotiviti’s Revenue Cycle Team to process payments.  The recovery team also collaborates with Cotiviti’s internal audit teams, along with healthcare payers and providers to understand health care billing concepts and help to ensure payment accuracy.

As a Recovery Resolution Specialist: the ideal candidate must be equipped to identify problems in the recovery and revenue cycle process for escalation to the appropriate parties both internally and externally as well as have excellent written and verbal communication skills for critical communication.

Additionally, a Recovery Resolution Specialist is to adhere to all operational guidelines for calling on clients who have outstanding balances and liaisons with accounts receivable on matters of risk associated with those customers as well as may be required to de-escalate and/or report possible client abrasion. A Recovery Resolution Specialist must have a high regard for attention to detail and accuracy in recording all documentation for received payments and tracking anything outstanding within our systems. Lastly, confidentially of Cotiviti’s information and privacy must be upheld to the highest level of security when working with data and assigned reporting ques.

Responsibilities

  • Follows established policies and procedures to collect identified claims. This includes contacting the providers to verify receipt of the claims and to obtain the status of any outstanding claims. Responsible for responding to correspondence, requesting additional information from providers, preparing documents, and other administrative tasks.
  • Investigates claim disputes as required. Identifies issues timely and escalates to appropriate parties. Provides accurate information, supporting documentation, and effective communication to complete recovery process.
  • Documents details in the system. Utilizes with increasing proficiency, proprietary reports, tools, and systems required to perform duties.
  • Maintains productivity goals and standards set by the department. Ensures all department rules and processes are followed. Alerts manager of system issues or other issues impacting productivity.
  • Achieves the expected level of quality set by the department. Verifies completeness and accuracy of work. Alerts manager of issues or concerns impacting quality of work.
  • Quickly grasps a working understanding of basic elements and concepts of audit operations. Demonstrates enthusiasm for learning and applying knowledge to the completion of tasks. Successfully integrates and executes new assignments with moderate guidance and direction.
  • Demonstrates adeptness in gathering data, analyzing problems, evaluating options, and developing/implementing creative solutions to job challenges. Makes logical, well-reasoned and timely decisions, seeking guidance and support as appropriate.
  • Demonstrates competency with tools of the job including but not limited to filing systems, computers, word processing & spreadsheet applications, web systems, Cotiviti and Client systems, data file structures and Power Point. Can efficiently download and format common file types.
  • Demonstrates ability to plan, organize, and prioritize multiple tasks and ensure timely completion. Uses a structured and dependable approach to accomplish work assignments.
  • Shows initiative and a willingness to engage in all audit support activities. Reaches beyond current tasks to add value to broader team. Goes the extra step to solve problems instead of waiting for someone else to solve them.
  • Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Assures confidentiality and security of all data, adhering to all HIPAA laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
  • Works with clients, customers, and partners to accurately assess their needs, provide information or assistance, resolve problems, or satisfy requirements.
  • Can be counted on to consistently meet or exceed goals and perform at expected levels of quality and productivity. Demonstrates willingness and readiness to take on more responsibility in support of the audit.
  • Complete all responsibilities as outlined on annual Performance Plan.
  • Complete all special projects and other duties as assigned.
  • Must be able to perform duties with or without reasonable accommodation.

Qualifications

  • High School graduate or equivalent education.
  • 0 -1 year of related experience of healthcare or collections preferred.
  • Computer proficiency in Microsoft Office applications and system databases are required.
  • Billing or coding experience preferred.
  • Requires working knowledge of and applicable industry-based standards.
  • Excellent verbal and written communication skills.
  • Ability to work well in an individual and team environment.
  • Has the ability to demonstrate analytical thinking and persuasive communication skills.
  • Must be detailed oriented and organized in recording and documented work products for the success of the department.
  • Ability to create and maintain collaborative partnerships.
  • Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

 

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