Manager of Overpayment Recovery Services

Overview

Under the direction of the Associate Director of Internal Audit or above, the Manager of

Overpayment Recovery Services is responsible for overseeing the Provider Check Posting and

Recovery Teams, while coordinating with administrative support to drive departmental

initiatives. This role ensures accurate posting of provider payments, reconciles discrepancies, and

manages the recovery of overpaid claims efficiently. The Manager will lead efforts to maintain

financial integrity and compliance through effective oversight of claims processing and recovery

operations.

Responsibilities

Team Leadership

• Manages the Provider Check Posting Team and Recovery Unit, including
  
  

recruitment, training, and performance oversight.

• Coordinates workflow and delegates tasks to ensure timely and accurate
  
  

completion of responsibilities.

• Directly oversees the quality of work performed by the Cost Avoidance and
  
  

Recoveries Team.

Prioritizes and delegates tasks and projects.

▪ Provider Check Posting Team Responsibilities

• Posts provider checks and process check reissues.
• Reconciles overpayments identified through internal audits and provider refunds.
  
  

Recovery Unit Responsibilities

• Prepares and reconciles check postings.
• Initiates recovery of overpaid claims and issues refund request letters.
• Collaborates with Claims to adjust claims and processes offsets.
• Reconciles letters to receivables and creates receivables as needed.
• Manages credit balance letters and monitors negative balances.
• Collaborates with the FWA team to oversee Fraud, Waste, and Abuse recoupment
  
  

monitoring activities and reports all recoupments to FWA.

• Works with Overpayment Research Unit to identify trends and recommend
  
  

corrective actions.

• Monitors advanced payment and payment plans.
  
  

Cross-Functional Collaboration

• Partners with Finance, Claims, and other departments to ensure accuracy and
  
  

compliance in payment processes.

• Provides reporting on recovery amounts, overpayment reasons, and reconciliation
  
  

status

Process Improvement

• Identifies and implements process enhancements to improve efficiency and
  
  

accuracy in cost avoidance and recovery operations.

Secondary Duties and Responsibilities

▪ Works with IT to ensure accuracy of downloaded databases related to OHC.

▪ Participates in special projects and assignments as needed.

▪ Other duties as assigned

Qualifications

Education and Experience

Bachelor’s degree in finance, Accounting, or related field preferred.

Minimum five (5) years of progressive experience in healthcare finance

or claims processing required; minimum two (2) years of managed care

Experience, Preferably Working With Medicaid And/or Other

government-sponsored programs; or an equivalent combination of

education and experience. Minimum of 3-5 years of experience in a

supervisory role required.

Special Skills, Licenses and Certifications

Knowledge of managed care finance principles and medical coding,

including ICD-9, ICD-10, CPT, and HCPCS. Technical expertise in

Business Objects, HighBond by Diligent, and/or ACL for use in data

mining, preferred; highly proficient in MS Office with emphasis on

advanced use of Excel. Ability to adapt to new technologies and

applications.

Performance Based Competencies

Excellent oral and written communication skills. Strong project

management skills. Ability to work independently to resolve issues.

Ability to work on multiple projects simultaneously, often under strict

time constraints and conflicting priorities. Ability to efficiently

coordinate workflow among staff. Ability to effectively explain

complex finance and utilize data in verbal, written, and graphical form.

Work Environment And Physical Demands

Ability to use a computer keyboard and 10-key calculator. Ability to

spend more than 70% of work time in front of a computer monitor.

When required, ability to move, carry, or lift objects of varying size,

weighing up to 10 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
  
  

HIRING RANGE:

$118,518.94 - $154,074.63

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.