Manager Claims Recovery
US-CA-BAKERSFIELD
commonspirit_careers
Req #: 431859
Type: Day
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Overview: The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Responsibilities: The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role oversees all efforts to identify, validate, and recoup overpayments, as well as enhance controls to prevent future payment errors. The Recovery Manager works in close coordination with internal audit, provider dispute resolution, and finance to maximize cost recovery, reduce payment errors, and support contractual compliance. Qualifications: Minimum Qualifications: * High School Graduate or GED * Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a multi-plan MSO or delegated entity. * Minimum 2 years of people management or team leadership experience. * Strong working knowledge of managed care contracts, provider reimbursement methodologies, and recovery-related policies (e.g., COB, TPL, retro reviews). * Proficiency in Microsoft Excel; familiarity with claims adjudication platforms (e.g., QNXT, EZCAP). Preferred Qualifications: * Bachelor's degree in Healthcare Administration, Business, Finance, or related field or equivalent work experience. * Experience managing vendor recovery relationships or large-scale recovery initiatives. * Familiarity with audit tools, denial management, and provider relations workflows * Knowledge of Medicare Advantage, Commercial, and Medi-Cal managed care recovery requirements.
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