Description

Recovery Audit Analyst II

Locations: Miami, FL; Tampa, FL; Atlanta, GA; Columbus, GA; Houston, TX; and Grand Prairie, TX.

• 9250 W Flagler St, STE 600, Miami, FL 33174

• 5411 Sky Center Dr, Tampa, FL 33607

• 740 W Peachtree St NW, Atlanta, GA 30308

• 6087 Technology Pkwy, Columbus, GA 31820

• 5959 Corporate Dr, STE 3500, Houston, TX 77036

• 2505 N Hwy 360, STE 300, Grand Prairie, TX 75050

Reasonable proximity (1-hour commute or a 50-mile radius) to one of the Elevance Health offices listed above is strongly preferred. Other highly skilled and qualified candidates will be considered who are still within reasonable proximity to one of our other Elevance Health PulsePoint's locations.

Schedule: This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days in an Elevance Health Major office (PulsePoint) per week . Elevance Health supports a hybrid workplace model with pulse point sites used for collaboration, community, and connection.

The Recovery Audit Analyst II is responsible for auditing and facilitating the recovery of claims overpayments as identified by our business partners. Also, responsible for research, analysis, documentation, outreach to providers, coordination of resolutions to overpayment issues, and recovery of identified overpayments.

How you will make an impact

Primary duties may include, but are not limited to:

• Posting checks for identified claims overpayments.

• Performs collection activities to ensure the recovery of overpayments and negative balance accounts.

• Works closely with contract managers to identify and correct contractual issues, if applicable.

• Conducts moderately complex case research and resolution for projects involving overpayments.

• Interprets provider contracts as they relate to overpayment opportunities and compliance with company, federal and state rules and regulations.

• Ensures high customer satisfaction when acting as a liaison between cost containment, health plans and high-profile providers in an effort to resolve overpayment recoveries.

• Assists in reviews of state complaints related to overpayments or negative balances.

• Facilitates the resolution of state complaints within strict timelines.

• Works with recovery and collection vendors to validate overpayments and vendor invoices.

• Provides feedback to modify queries, as needed.

• Performs claim and trend analysis, validation, and recovery of claims payment errors.

Minimum Requirements:

• Requires a BA/BS and a minimum of 4 years of experience; or any combination of education and/or experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• 3 years of cost containment experience preferred.

• Claims familiarity or background preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.