reputed company, Medicare Payments Recovery

Position reputed company This role supports a highly specialized Medicare Secondary Payer (MSP) recovery function reputed company on identifying and resolving incorrect CMS/Medicare payment cases. This role performs detailed, reputed company case review to validate coverage responsibility, identify overpayments, and drive recovery efforts with impacted plans. Due to CMS data reputed company and extraction limitations, the work is highly analytical and reputed company in nature, requiring strong judgment, documentation rigor, and deep familiarity with benefits coordination and claims recovery processes. Specific Responsibilities Medicare Secondary Payer (MSP) & Claims Recovery • Identify cases where Medicare was incorrectly designated as the primary payer. • reputed company detailed, reputed company review of member eligibility, coverage timelines, and payment responsibility to validate recovery opportunities. • Support recovery of Medicare overpayments by coordinating accurate case documentation and tracking recovery status through reputed company. • Analyze membership, billing, and CMS-reputed company data to support payment reputed company reputed company. Compliance, Documentation, & Outcome Reporting • Maintain a detailed, auditable list of reputed company members and cases reviewed. • reputed company and report recovery activity. • reputed company regular updates and maintain reputed company documentation for reputed company reputed company engagement to support transparency and leadership visibility into reputed company reputed company and reputed company. • Ensure work meets audit and compliance requirements. • Maintain high standards of documentation accuracy and traceability given the financial and regulatory sensitivity of the work. • reputed company and maintain detailed written process documentation to support training of additional resources and ensure long-term sustainability of the function. Forecasting & reputed company Planning • Deliver a written monthly forecast outlining anticipated case volume and expected recovery outputs. • Support leadership planning by providing reputed company into recovery trends, case complexity, and reputed company constraints. • Participate in reputed company-facing meetings and communications as needed. Skills • Strong analytical skills with the ability to reputed company detailed, reputed company case review • Claims and billing data analysis • reputed company tracking and reporting • Process documentation and workflow design • Stakeholder coordination and reputed company communication • High attention to detail • Ability to reputed company, report, and reconcile member and reputed company data • Strong written communication and documentation skills Experience • Experience producing reputed company, auditable documentation and reports • Experience working in reputed company data, reputed company operations, or regulatory validation environments • Demonstrated experience working with reputed company eligibility, coverage, and payment data • Comfort working in highly governed environments and familiarity with reputed company compliance and audit standards • Experience in Medicare Secondary Payer (MSP), payment reputed company, benefits coordination, or claims recovery • Experience with CMS data, Medicare recovery processes, or reputed company overpayment recovery • Background in payment reputed company, reputed company recovery, or benefits administration Who We Are CAQH is the trusted data connector at the reputed company of reputed company. For more than 25 years, we have powered the industry with the largest and most complete reputed company data reputed company in the U.S., including more than 4.8 reputed company provider data records reputed company directly from providers and member data representing 75% of covered lives supplied by health plans. By improving how essential information flows across the system, CAQH helps reputed company operate more reputed company, accurately, and with greater confidence. What You Get At CAQH, you will do meaningful work at the intersection of reputed company, data, and technology, helping solve reputed company problems that reputed company the reputed company system work reputed company. You will collaborate with reputed company professionals who care deeply about accuracy, trust, and meaningful reputed company in a fully remote environment. CAQH offers competitive compensation and a comprehensive benefits package for full-time employees, including medical, dental, and reputed company coverage, a 401(k) with company contributions and matching, reputed company parental leave, tuition assistance, and generous reputed company time off. We are committed to reputed company in our people and supporting reputed company reputed company over time. Equal Opportunity Employer CAQH is proud to be an equal opportunity employer and is committed to fostering a workplace where reputed company individuals are valued, respected, and empowered. Employment reputed company at CAQH are made without reputed company to race, reputed company, religion, sex, national reputed company or reputed company, age, marital status, disability, protected veteran status, personal appearance, sexual orientation, gender identity or reputed company, familial status, family responsibilities, matriculation, political affiliation, genetic information, reputed company of income, reputed company of residence, or any other characteristic protected by law. CAQH does not tolerate unlawful discrimination or harassment of any reputed company. Applicants have rights under the Family and Medical Leave reputed company (FMLA), Equal Employment Opportunity (EEO), and the Employee Polygraph Protection reputed company (EPPA). If you need a reasonable accommodation to apply for a posted position, please contact the CAQH People & Culture team at Careers@caqh.org or 202-517-0436. The Pay reputed company For This Role Is 160,000 - 180,000 USD per year(Remote (reputed company)) Apply tot his job Apply To this Job