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Corporate Functions & Operations WellCare - Operations Support Careers

Cost Containment Coordinator Job

Full Job Title: Cost Containment Coordinator

Job Number: 1806366

Location: Tampa, FL

Date Posted: 2018-09-10

Department: Operations- Payment Integrity

Reports to: Supv, Cost Containment

Location: Idlewild Ave, Tampa, FL

Responsible for verifying potential overpaid medical claims for all lines of business and performing a recovery adjustment as appropriate. Compared to the senior role, this position will process a lesser volume of complex claims but will still be held accountable for productivity and quality standards.
Essential Functions:
  • Handles claims training and performs complex assignments independently.
  • Process overpayment adjustments for all medical claim types and all lines of business.
  • Responsibilities include the ability to independently interpret contracts, verify fee schedules, use CMS and HSS pricing tools.
  • Assist with researching and following-up on 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.
  • Performs special duties or tasks within scope of the CCU.
Education: High School diploma or equivalent
Experience: Requires 1 year of facility and professional claims processing experience in a healthcare organization. Internal candidates must also meet key performance metrics.
Technical Skills/Requirements: Familiar with PC software including Outlook, Word and Excel

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Last Updated On: 12/9/2015