Overpayment Recovery Team Lead

The Phia Group provides amongst other things claim recovery services for health benefit plans. When a health benefit plan pays medical bills and we later discover someone else should have paid those medical bills The Phia Group on behalf of the health plan will seek to recover the funds.

At The Phia Group whose mission is to provide high quality yet affordable healthcare to American employees and their dependents you can look forward to not only exceptional benefits for yourself but also being immersed in a company that has been named one of USA Todays top workplaces for 2024. We believe that this distinction which stems from the fourth-annual survey co-sponsored by Energage and USA Today reflects our unwavering commitment to upholding an internal culture of inclusivity enjoyment and empathy for our valued employees.

The Overpayment Recovery Team Lead plays an important role in this effort by not only pursuing reimbursement of overpayments but also managing the team responsible for the day-to-day case handling responsibilities. As a member of the team you will be responsible for verifying and overseeing the importation of client data (which is used to both identify opportunities and defend our right to recovery) establishing contact with the providers to advise of our intent to collect overpaid claims auditing cases to ensure proper procedures are adhered to managing team KPIs ensuring complete and timely responses to client inquiries and regularly meeting with the case handlers to support any concerns needs or questions.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Establishing written contact with providers notifying them of reimbursement request and provide supporting documentation
• Promptly respond to provider communication regarding overpayment disputes using information found in Plan Documents PPO contracts as well as state and federal regulations
• Complete miscellaneous client requests. (injury reports under threshold reports etc.)
• Overseeing importation of and verifying client data
• Conducting mail merges of client data in order to send out initial and follow-up letter correspondence requesting refunds
• Prepare emails to clients for further clarification regarding reasons for refunds on an as needed basis
• Review files to be transferred to in house legal department once all recovery options have been exhausted for providers that have not responded to and/or disputed overpayment requests
• Uses MS Word Excel Microsoft Outlook and other programs in preparation of correspondence and/or documents
• Ensuring time sensitive documents are properly addressed
• Managing team needs and requests
• Running team meetings
• Auditing case files
• Running and analyzing KPIs

Experience and Qualifications

• Excellent attention to detail with the ability to multi-task
• Excellent communication skills
• High level of proficiency using Microsoft Word and Excel required
• Outstanding organizational interpersonal and administrative skills
• Excellent telephone writing and communication skills
• Must be self-motivated and able to meet deadlines under pressure
• Must have the ability to work as part of a team as well as to work independently
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Associates Degree or High School Diploma
• Proficient in Microsoft Word and Excel
• Ability to read write and speak the English Language.
• Must have ability to define problems collect data establish facts and draw valid conclusions
• Minimum of 3 years experience in management

Working Conditions / Physical Demands

Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer copiers and fax machines.

This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements the company reserves the right to modify add or remove duties and assign other duties as necessary.

Salary: $55000 - 65000 / year

External and internal applicants as well as position incumbents who become disabled as defined under the Americans with Disabilities Act must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.