BlueCross BlueShield of South Carolina
Overpayment Recovery Analyst - CGS
BlueCross BlueShield of South Carolina, Nashville, Tennessee, United States, 37247
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Overpayment Recovery Analyst - CGS
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Overpayment Recovery Analyst - CGS
role at
BlueCross BlueShield of South Carolina Summary
Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis. Summary
Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis.
Description
What You’ll Do.
Conducts onsite or desk audits of hospitals and provider facilities to identify overpayments and compliance with government regulations, which may include Medicare Secondary Payer (MSP) regulations. Analyzes provider contracts to determine the proper reimbursement of inpatient and outpatient benefit payments and calculates correct refunds. Performs comprehensive review and responds to complex inquiries of all varieties of provider facilities. This may include the review, trending, analysis, and executive report of all claims actions. Identifies potential fraud and abuse situations and refers documented findings to appropriate area for investigation. Develops comprehensive financial strategies and master audit programs for hospitals and provider reviews. Conducts outreach workshops and training sessions for appropriate groups to focus on problem areas relating to government regulations and billing issues. May coordinate research and reporting functions for the MSP prepay claims department.
Required Education
Bachelor’s degree in Business Administration or other related field OR Four years billing/reimbursement, hospital finance/overpayment recovery, or MSP experience. Required Work Experience
Six years of experience with health insurance claims and/or hospital billing procedures and/or MSP.
Required Skills And Abilities
Analyzes provider contracts. Conducts provider compliance audits. Identifies potential fraud situations. Makes recommendations for corrective actions. Produces monthly summary reports.
Required Software And Tools
Microsoft Office.
Work Environment
Typical office environment.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
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Overpayment Recovery Analyst - CGS
role at
BlueCross BlueShield of South Carolina 1 day ago Be among the first 25 applicants Join to apply for the
Overpayment Recovery Analyst - CGS
role at
BlueCross BlueShield of South Carolina Summary
Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis. Summary
Identifies, researches, and investigates providers for aberrant and abusive billing practices against the company and its subsidiaries. Analyzes hospital accounting records for overpayments and fraudulent billing to the corporation. Identify potential fraud and abuse situations through document review and analysis.
Description
What You’ll Do.
Conducts onsite or desk audits of hospitals and provider facilities to identify overpayments and compliance with government regulations, which may include Medicare Secondary Payer (MSP) regulations. Analyzes provider contracts to determine the proper reimbursement of inpatient and outpatient benefit payments and calculates correct refunds. Performs comprehensive review and responds to complex inquiries of all varieties of provider facilities. This may include the review, trending, analysis, and executive report of all claims actions. Identifies potential fraud and abuse situations and refers documented findings to appropriate area for investigation. Develops comprehensive financial strategies and master audit programs for hospitals and provider reviews. Conducts outreach workshops and training sessions for appropriate groups to focus on problem areas relating to government regulations and billing issues. May coordinate research and reporting functions for the MSP prepay claims department.
Required Education
Bachelor’s degree in Business Administration or other related field OR Four years billing/reimbursement, hospital finance/overpayment recovery, or MSP experience. Required Work Experience
Six years of experience with health insurance claims and/or hospital billing procedures and/or MSP.
Required Skills And Abilities
Analyzes provider contracts. Conducts provider compliance audits. Identifies potential fraud situations. Makes recommendations for corrective actions. Produces monthly summary reports.
Required Software And Tools
Microsoft Office.
Work Environment
Typical office environment.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Business Development and Sales Industries Insurance Referrals increase your chances of interviewing at BlueCross BlueShield of South Carolina by 2x Get notified about new Recovery Analyst jobs in
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