Cost Avoidance Specialist I

Job description

Overview Under the direction of the Cost Avoidance Supervisor, the Cost Avoidance Specialist I monitors activities related to cost savings and recoveries of medical claim payments; identifies and verifies members other health coverage (OHI), updates system and recovers overpayment, and researches and validates provider refund checks. The Cost Avoidance Specialist interfaces with all departments in an information sharing capacity to promote proper payment procedures and timely cost effectiveness in claims payments. Responsibilities: Researches and validates all provider refund checks received with duties including but not limited to: - Assess, implement, and monitor activities related to recoveries and cost savings of medical claims with duties including but not limited to: - Perform assessments and identify potential overpayments on claims related to all lines of business; - Research and identify overpayments related to over utilization of procedures, billing procedures, potential fraudulent claims, duplicate payments, and overpayments due to lack of coordination of benefits with member's primary health care insurance policy such as a private health insurance, Medicare coverage, or...