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Cost Containment Coordinator, Sr - Tampa

Company: Wellcare Health Plans
Location: Tampa
Posted on: November 11, 2019

Job Description:

Primary responsibility is to verify potential overpaid medical claims for all lines of business and performing recovery adjustments as appropriate.Department: Ops-Claims IReports to: Supv. Cost Containment UnitLocation: Tampa, FLEssential Functions:Process complex overpayment adjustments for all medical claim types and all lines of business.Responsibilities include independently interpreting contracts, WellCare guidelines, Policies and Procedures, verifying fee schedules, using CMS and HSS pricing tools.Works on validation of new overpayment edits from vendors and recovery analyst.Researches and follows-up on complex recovery issues and escalated requests.While processing unsolicited refunds, identify systemic set-up issues or manual adjudication patterns for potential quality improvement and greater overpayment recovery opportunities.Assist with the training and mentoring of new hires and less experienced associates.Coordinates benefits on the claims.Performs special duties or tasks within scope of the CCU. Additional Responsibilities:Overtime may be required based on business need.Candidate Education:Required A High School or GED Candidate Experience:Required 3 years of experience in facility and professional claims processing in a healthcare organizationPreferred 1 year of experience in Claims Recovery. Internal candidates must also meet key performance metrics. Candidate Skills:Licenses and Certifications:A license in one of the following is required:Technical Skills:Required Intermediate Microsoft Outlook Familiar with PC software including Outlook, Word and ExcelRequired Intermediate Microsoft WordRequired Intermediate Microsoft Excel Languages:About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Tampa , Cost Containment Coordinator, Sr - Tampa, Other , Tampa, Florida

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