Cash Recovery Specialist

Note: (1) day per week in-office requirement in Brooklyn, Ohio.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsibilities

Cash Recovery Specialist

Reviews and research routine to moderately complex refunds and returned checks to determine the reason for refund and validity. Identifies the appropriate claims to allocate, makes claim adjustments and/or applies refund against an outstanding invoice or receivable. Researches and analyzes account receivable balances against historical information to determine source/reason for adjustment and confirms claims were adjusted according to policies/procedures and regulatory guidelines. Makes initial/follow-up phone calls for collection. Assists with Disbursements related to monitoring and tracking the timeliness of claims processing.

* Reviews routine to moderately complex refunds and returned checks for paid claims. Research departmental and membership data/files to determine appropriate action for overpayments received from providers and subscribers. Adjusts claims in accordance with corporate policies/procedures and regulatory guidelines.

* Provides analytical and technical support for internal departments to ensure claims are resolved. Identifies issues or trends and works with the appropriate departments to recommend policies/procedures revisions.

* Analyzes accounts receivable balances to determine the validity of the claim adjustment prior to initiating a collection call. If valid, initiates communication via phone, letter and/or e-mail for the collection of open receivables. Escalates uncollectable receivables and coordinates with external collection vendor.

* Runs canned queries for department to analyze claims data for the purposes of insuring payment integrity and accuracy.

* Assist with disbursements related functions (i.e., releasing of claims, direction of payment changes, claim adjustment projects, etc.).

* Performs other duties as assigned.

Senior Cash Recovery Specialist

Reviews and research moderately complex to complex refunds and returned checks to determine the reason for refund and validity. Identifies the appropriate claims to allocate, makes claim adjustments and/or applies refund against an outstanding invoice or receivable. Researches and analyzes account receivable balances against historical information to determine source/reason for adjustment and confirms claims were adjusted according to policies/procedures and regulatory guidelines. Makes initial/follow-up phone calls for collection. Assists with Disbursements related to monitoring and tracking the timeliness of claims processing.

* Reviews moderately complex to complex refunds and returned checks for paid claims. Research departmental and membership data/files to determine appropriate action for overpayments received from providers and subscribers. Adjusts claims in accordance with corporate policies/procedures and regulatory guidelines.

* Provides analytical and technical support for internal departments to ensure claims are resolved. Identifies issues or trends and works with the appropriate departments to recommend policies/procedures revisions.

* Analyzes accounts receivable balances to determine the validity of the claim adjustment prior to initiating a collection call. If valid, initiates communication via phone, letter and/or e-mail for the collection of open receivables. Escalates uncollectable receivables and coordinates with external collection vendor.

* Works with internal departments for accountability following secured processing of credit card payments.

* Runs canned queries for department to analyze claims data for the purposes of insuring payment integrity and accuracy.

* Assist with disbursements related functions (i.e., releasing of claims, direction of payment changes, claim adjustment projects, etc.).

* Performs other duties as assigned.

Qualifications

Cash Recovery Specialist

* Associate Degree in Business or Healthcare Administration or related field, or equivalent education/training and experience.

* 3 years of experience in health plan claims/customer service, collections, accounts receivable or related operations.

* Internal experience preferred.

* Thorough knowledge of claims adjudication, membership, customer care and related systems.

* Basic proficiency with SAS, SQL, or DB2 applications.

* Intermediate Microsoft Office, OnBase, database reporting skills.

* Knowledge of health claims adjudication processing.

* Strong math and bookkeeping skills.

* Knowledge of accounts receivable and collections procedures.

Senior Cash Recovery Specialist

* Associate Degree in Business or Healthcare Administration or related field, or equivalent education/training and experience.

* 2 years of experience as a Cash Recovery Specialist or equivalent 5 years of experience in health plan claims/customer service, collections, accounts receivable or related operations.

* Internal experience preferred.

* Thorough knowledge of claims adjudication, membership, customer care and related systems.

* Basic proficiency with SAS, SQL, or DB2 applications.

* Intermediate to advanced Microsoft Office, OnBase, database reporting skills.

* Knowledge of health claims adjudication processing.

* Strong math and bookkeeping skills.

* Knowledge of accounts receivable and collections procedures.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.