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GENERAL STATEMENT OF JOB

The Recovery Coordinator position will develop and oversee the process for identifying claims in which third parties are responsible, for coordinating the communication with the internal stakeholders, responsible third parties, the Department, appropriate legal representatives, and for facilitating recovery of claims payments from the third parties, as warranted.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS

Recovery Coordination: 100%

• Develop and oversee the process for identifying claims in which third parties are responsible
• Coordinating the communication with the internal stakeholders, responsible third parties, the Department, appropriate legal representatives, and for facilitating recovery of claims payments from the third parties, as warranted.
• Demonstrate professionalism, an ability to effectively communicate information that may be technical or complex in nature to a variety of different people, including claimants and attorneys, tenacity, assertiveness and, most importantly, a deep desire to garner positive, appropriate subrogation outcomes
• Reviews claim files to identify, evaluate, analyze and interpret third party responsibility potential
• Evaluates completeness and accuracy of documentary evidence; records and processes all recovery payments; prepares and issues payments for recovery
• Reviews, approves and coordinates appropriate steps to secure evidence and ensure pursuit, development and recovery of claims
• Review, approve, monitor and file claims with appropriate documentation attached
• Monitor, track and process all incoming and outgoing correspondence as assigned
• Develops, reviews, approves, maintains, produces, administers and distributes accurate and complete recovery reports as required
• Tracking and monitoring of the recovery accounts receivable activity including communications with internal and external stakeholders
• This position is a member of the Investigation Oversight Committee (IOC) which facilitates the appropriate, timely investigation of all allegations of contracted provider noncompliance with Vaya policies and procedures, payer program requirements and applicable federal and state laws, rules and regulations, and reviews all provider paybacks and payment plan arrangements to ensure compliance.
• Other duties as assigned.

KNOWLEDGE, SKILL & ABILITIES

• Positive and cooperative attitude in working and communication with individuals at all levels of the organization
• Experience with computer operation and Microsoft Office products
• Ability to organize a large volume of documents and workload to meet payment deadlines
• Ability to exercise judgment and discretion in establishing, applying, and interpreting policies and procedures
• Ability to establish and maintain effective working relationships with agency personnel, officials, and the general public
• Extensive knowledge of employee benefits and applicable laws.
• Excellent written and verbal communication skills.
• Excellent organizational and time management skills.

QUALIFICATIONS & EDUCATION REQUIREMENTS

High School Diploma or GED with three (3) years of medical billing knowledge.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: Must reside in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit

Vaya Health is an equal opportunity employer.