Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Recovery Specialist will participate in the development, implementation and maintenance of adjustments and recovery for the Claims Department staff and claims processing system. Assure the delivery of high quality technical direction, guidance and support to improve process and procedures of the Claims Department. Specific duties and responsibilities include:
- Understand and accurately interpret the health plans member, provider and practitioner contracts, rider policies, product lines and procedures.
- Identify and implement potential improvements in automated or manual processes.
- Ensure quality of data collection through adjustment and recovery process to meet or exceed standards. Complete reports, audits and authorizes payment of claims over examiner’s limits.
- Collect, analyze and manage adjustment data for quality improvement needs. Coordinate or support collections, analysis and management of network performance data.
- Support unit, departmental and divisional teams through participation in meetings and projects. Interact with other supervisors and staff from other departments to resolve mutual problems.
- Responsible for running Ingenix claims reports, member eligibility requests, and detailed claims information.
- Recover of AIM identified overpayments.
- Recover overpayments identified in the CORS software.
- DHS/CMS and HTHP encounter error reports. Investigate and identify error issues, work with other departments to resolve them.
- Work with Providers to help them understand reason for CORS identified overpayments.
- Manage the CORS Recovery phone inquiries and maintain phone log.
A high school diploma is required. Two or more years of medical claims examiner and adjustment experience. CPT and ICD-9 coding, and medical terminology is also required. Working knowledge of Amisys system or equivalent experience with other claims systems is necessary. Knowledge of imaging systems is preferred.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.