Cost Containment Coordinator, Sr.

Primary responsibility is to verify potential overpaid medical claims for all lines of business and performing recovery adjustments as appropriate.

Reports to: Supv, Operations

Department: AZ-Ops Claims-M'Caid

Position Location: Phoenix, AZ



Essential 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 organization
  • Preferred 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 Excel
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Excel
      Languages:

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. 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.