Cost Containment Coord, Lead

Primary responsibility is to validate overpayment recovery projects assigned to CCU and work with Recovery team to determine recovery opportunities and provide recommendations to optimize identification of selected population.

Location: Idlewild Ave, Tampa, FL

Department: Ops-Payment Integrity Unit

Reporting to: Supv, Cost Containment

Essential Functions:
  • Validate overpayment recovery projects and coordinate approval with Recovery team.
  • Lead role in utilizing hot key (adjustment scripts) applications and trouble-shooting errors.
  • Subject Matter Expert (SME) in all areas.
  • Responsibilities include independently interpreting contracts, WellCare guidelines, Policies and Procedures, verifying fee schedules, using CMS and HSS pricing tools, performing coordination of benefits, application of member responsibility.
  • Process overpayment adjustments for all medical claim types and all lines of business.
  • Take lead with researching and following up on complex recovery issues and escalated requests.
  • Take lead with validation of new overpayment edits from vendors and Recovery team.
  • Assist with mentoring and auditing of new hires and less experienced associates.
  • Builds and maintains positive business relationships with business partners.
  • Participate and attend conference calls with supervisor or Recovery team to help facilitate overpayment recovery findings at market meetings.
  • Performs other duties as assigned and required.
Education: High School diploma or equivalent
Experience: Requires 5 years of facility and professional claims processing experience in a healthcare organization.
Strong working knowledge ICD-9, CPT-4, HCPC and other code sets.
Experience with researching provider contracts, configuration set-up and State and CMS regulations.
Requires 3 years minimum of Claims Recovery experience. Internal candidates must also meet key performance metrics.
Licenses/Certifications: CPA Certification preferred.
Special Skills (e.g. 2nd language): Ability to meet deadlines, follow directions and remain flexible with job responsibilities. Strong analytical and problem solving skills.
Technical Skills/Requirements: Intermediate to advanced knowledge of Microsoft Office

About us
Headquartered 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.