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Recovery Data Analyst, Sr - TPA Idlewild
  • Data Analysis
  • Excel
WellCare
Tampa, FL 33634
135 days ago

At WellCare, we are a passionate team with a strong mission and a focused purpose: to serve our members and local communities in which they live while helping them lead better, healthier lives. Our culture is one of empowerment, teamwork and commitment as we all work together to deliver cost-effective solutions that create positive outcomes for our members. Join us in a career that inspires passion and purpose across all levels and disciplines within our award-winning organization.

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.Reports to: Manager, Recovery Data AnalystDepartment: Ops-Payment IntegrityLocation: Tampa, FL 33634
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:

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

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