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Accounting & Finance WellCare - Finance Careers

Recovery Data Analyst - Senior Job

Full Job Title: Recovery Data Analyst, Sr

Job Number: 1702205

Location: Tampa, FL

Date Posted: 7-13-2017

Location: Woodland Center Blvd/Idlewild Ave, Tampa FL

Department: Ops-Payment Integrity

Reporting to: Mgr, Recovery

Performs 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.

Essential Functions:

  • Acts as team lead on large projects requiring coordination with multiple departments within and outside the company.
  • 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.
  • Assists in designing and implementing relational data structures related to overpayment issue.
  • Summarizes information for business partners for review and resolution and provides recommendations on recovery strategies.
  • Monitors progress of overpayment projects and executes on next step
  • Develops comprehensive and detailed analyses on erroneous payments in order to support the revenue collection and reconciliation process.
  • Develops complex data queries to generate reports of overpaid claims
  • Mentors junior recovery analysts
  • Ownership and oversight of specific recovery processes
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in in related field
  • Required or equivalent work experience
Candidate Experience:
  • Required 5 years of experience in Business criteria development
  • Required 5 years of experience in Claims processing, Claims Operations or Claims recovery
  • Required 1 year of experience in Data Analysis
Candidate Skills:
  • Advanced Demonstrated analytical skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Advanced Ability to lead/manage others
  • Advanced Other Excellent problem analysis skills
  • Advanced Other Excellent consultative skills
  • Advanced Other Excellent judgment skills
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:Languages:

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Last Updated On: 12/9/2015