Profile
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Under limited supervision, manages and performs claims department activities related to recoupments and collections, including validation of recoupment setup, conducting collections calls with providers, establishing payment arrangements, tracking and trending outstanding recoupments, establishing payment arrangements, and coordinating collections activities with other departments.
Education & Experience
Required:
- High School diploma or GED
- 2+ years of healthcare billing or medical claims processing experience
- Claims research skills, to include healthcare policy
- Experience building relationships and using influencing skills
- Experience using Excel to track, trend and report on data
- U.S. Citizenship
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
Preferred
- Bachelor’s (BS/BA) Degree in health care or related field or equivalent experience
- 2 years of Government claims experience
- Collections experience
- Quality or process improvement experience
Key Responsibilities
- Under limited supervision, manages the recoupment process and identifies opportunities for improvements.
- Works with Provider Services, Finance, Legal, and Subcontractors to ensure successful recoupment outcomes.
- Makes outbound calls to providers to notify of and discuss recoupments.
- Coordinates payment arrangements.
- Tracks and advises management of outstanding recoupments.
- Tracks and reports payment plan status.
- Recommends outstanding accounts be set up with collections.
- Conducts complex claims policy research.
- Serves as submit matter expert resource to team members, supervisors, and other management teams.
- Performs other duties as assigned.
- Regular and reliable attendance is required.
Competencies
Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
Information Management: Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Technical Skills: Thorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract.
Working Conditions
Working Conditions
- Favorable working conditions in a climate controlled office space; must be available to cover any work shift; works within an office environment with minimal travel required; level II IT security clearance.
- Extensive computer work with prolonged sitting
- Security clearance as required by contract
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $53,676- $56,658 depending on experience*
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
