Overpayment Recovery Analyst - CGS

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 fieldOR
• 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 disabilitiesand 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.comor 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.

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