Manager Claims Recovery
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Job Location:
Bakersfield, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Where Youll Work
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Job Summary and Responsibilities
The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role oversees all efforts to identify validate and recoup overpayments as well as enhance controls to prevent future payment errors. The Recovery Manager works in close coordination with internal audit provider dispute resolution and finance to maximize cost recovery reduce payment errors and support contractual compliance.
Job Requirements
Minimum Qualifications:
- High School Graduate or GED
Minimum 5 years of progressive experience in healthcare claims recovery payment integrity or post-payment audit functions preferably within a multi-plan MSO or delegated entity.
- Minimum 2 years of people management or team leadership experience.
- Strong working knowledge of managed care contracts provider reimbursement methodologies and recovery-related policies (e.g. COB TPL retro reviews).
- Proficiency in Microsoft Excel; familiarity with claims adjudication platforms (e.g. QNXT EZCAP).
Preferred Qualifications:
- Bachelors degree in Healthcare Administration Business Finance or related field or equivalent work experience.
- Experience managing vendor recovery relationships or large-scale recovery initiatives.
- Familiarity with audit tools denial management and provider relations workflows
- Knowledge of Medicare Advantage Commercial and Medi-Cal managed care recovery requirements.
Required Experience:
Manager
Key Skills
- Corporate Paralegal
- Baan
- IT Sales and Marketing
- Civil Quality Control
- Activex
- Jboss
About Company
Dignity Health provides compassionate, high-quality, affordable health care services throughout Arizona, California and Nevada. Schedule an appointment today!
