Financial Recovery & COB Leader

Summary

Responsible for Financial Recovery (including Recovery Vendors) and Coordination of Benefits for the organization.Collaborate on strategic planning and provide oversight of development and implementation of best practices; establish and then maximize probability for successful achievement of goals and metrics; provide leadership across and with various internal and external business partners.Build relationships with Enterprise provider network (PNM) leaders: Operations, Claims, PFO, Configuration, IT, Medical Economics, etc. across the organization to develop and operationalize recovery and coordination of benefits efforts.Partner with organizational leads to influence provider satisfaction by implementing projects and best practices around our policies and financial recovery practices.Oversee SLA’s specific to our relationship with CTS; ensure full compliance for state or federal regulations relative to proper financial recovery activities.

Accountabilities

Direct all claims payment recovery activities (subrogation, credit balances, payment errors, etc.) to meet established financial targets.Responsible for oversight and maintenance of all internal and vendor related workflows and all financial reporting requirements.Responsible for the direction of all Coordination of Benefits (COB) activities for the organization including oversight and maintenance of all internal and vendor related workflows. Responsible for the direction of the recovery and collections vendor program for the organization. Identify and establish additional recovery vendor relationships in any other “gap areas” of pre- and post-payment claim recovery.Utilize vendor data to identify opportunities to insource processes/functions where appropriate.Daily oversight of the Cognizant vendor Financial Recovery and Coordination of Benefits activities; provide feedback to the vendor in support of these activities.Responsible for development of an SLA review program.Partner with Operations, Payment Integrity, and IT to identify opportunities to improve our processes, our human & technological capabilities in support of reduction of the occurrence of overpayments, and our ability to recover overpayments which do occur.

Requirements

Bachelor’s degree in Healthcare, Business, or related field required; Master’s preferred10 – 12+ years of relevant, professional work experience required8 – 10+ years’ experience in a health care environment, preferably including vendor interaction/management required5+ years’ experience managing staff/processes requiredWorking knowledge of contracts, SLAs, metrics, and other relevant means to measure performance requiredWorking knowledge of applicable regulations, best practices in financial recovery requiredExcellent communication skills (verbal, written, interpersonal, presentation) with all types/levels of audience requiredAbility to effectively negotiate, influence, collaborate and persuade requiredAbility to effectively organize, prioritize, and manage multiple tasks/projects with simultaneous conflicting deadlines requiredStrong analytic, decision-making, and problem-solving abilities requiredProficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) requiredDemonstrated leadership skills in a matrix environment required

Additional Information

Requisition ID: 1000001622Hiring Range: $86,000-$165,000