Trinity Health Cost Recovery Specialist in Maywood, Illinois

Reporting to the Operations Manager, the Cost Recovery Specialist is responsible for claims and capitation check runs and the oversight of recovery activities including overpayments. This position is located in Westmont, IL.

Minimum Education:

Required:Associate Degree or 10 years of experience in healthcare claims role

Preferred:Bachelor Degree or 5 years of**experience in healthcare claims role

Specify Degree(s):business/healthcare related


Minimum Experience:

Required:10 years of previous job-related experience

Preferred: 15 years of previous job-related experience

Details:10 + years experience processing medical claims or related experience, reviewing provider claims appeals, health plan communications. Familiarity with managed care products.

Managerial Experience:none

Performs capitation and claims pre-check run duties including recoupment of overpayments, review of appeals and reporting of recovery activity relating to claims overpayments and applying refunds as necessary.

Process incoming provider and member appeals related to claims payment and/or denial of services within required timeframes.

Receive and respond to medical group inquiries from the health plans. Compile requested information and confirm action to be taken, then communicate to appropriate teams.

Member max out of pocket adjustments as received form the health plan, which includes claims reversals and proper payment to provider rendering service.

Reviews and implements the electronic funds transfer (EFT) process.

Oversees and maintains system related software specific to overpayment programs.

Participates in upgrade team as a tester and process reviewer as system or related software is upgraded.


Job Number: 00116920

Location: Maywood, IL

Organization Name: Loyola University Medical Center

Facility: LUHS-Loyola University Medical Center

Employment Type: Full time

Hours: 40