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Recovery Data Analyst Job

Full Job Title: Recovery Data Analyst

Job Number: 1806481

Location: Tampa, FL

Date Posted: 2018-09-14

Performs advanced and in-depth data analysis and provider profiling to determine recovery opportunities for claims that are overpaid due to retroactive member termination, inappropriate coding, duplication of payments, non-authorized services, erroneous contract or fee schedule reimbursement, non-covered benefit(s) and other reasons. Provide recommendations to reduce future occurrences of overpayments.

Location: Hoover Blvd, Tampa, FL

Department: Ops-Payment Integrity

Reporting to: Sr Mgr, Recovery

Essential Functions:

  • Analyzes contractual obligations and identifies/pursues overpayments on claims for various reasons.
  • Prepares detailed analyses on mis-paid claims with complex business requirements and partners with IT resources for data pulls, analysis, and validation.
  • Summarizes information for business partners for review and resolution and provides recommendations on recovery strategies.
  • Monitors progress of overpayment projects and executes on next steps.
  • Develops comprehensive and detailed analyses on erroneous payments in order to support the revenue collection and reconciliation process.
  • Develops simple data queries to generate reports of overpaid claims
Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred A Bachelor's Degree in a related field
  • Preferred or equivalent work experience
Candidate Experience:
  • Required 3 years of experience in data analysis and business criteria development
  • Required 3 years of experience in Claims processing, Claims Operations or Claims recovery
Candidate Skills:
  • Intermediate Demonstrated analytical skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated problem solving skills
  • Intermediate Ability to influence internal and external constituents
Licenses and Certifications:
A license in one of the following is required:
    Technical Skills:

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        Last Updated On: 12/9/2015