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Director, Recovery Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1200149
Categories:  For-Profit Senior Services
Job Role:  Maintenance / Facilities Mgmt / Building & Grounds
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. For more information about WellCare, please visit the Company's website at www.wellcare.com.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national prescription drug plan provider and the largest Medicaid plan in Georgia. WellCare expanded its services when it began offering Medicaid managed care plans in Ohio and Missouri in 2007, and Medicare managed care plans in Texas and New Jersey in 2008. Additional growth followed when the company was chosen to serve Hawaii�s Medicaid program for the aged, blind or disabled in 2009, and in 2011 when it was selected to serve Kentucky�s Medicaid program. Today, WellCare has more than 3,900 associates and approximately 2.4 million members nationwide.

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.
Directs corporate-wide overpayment recovery efforts that include management of metrics, internal and external staff, reporting systems as well as vendor relationships.

 


Essential Functions:



  • Directs identification and pursuit overpayments and TPL avoidance across all business lines for both medical and pharmacy fee for service expenses.

  • Directs cost benefits analysis to determine if the functions and activities required to identify, pursue and post  overpayments should be internal or outsourced.

  • Directs the distribution and monitors standards such as turn around time, production and quality to managers of analytical and operational staff.

  • Directly develops business plans and sets financial targets to achieve desired goals. 

  • Reviews and directs muliple units performance to enhance financial operations in support of medical cost reduction.

  • Directs the deployment of staff and technology to capture, prepare, analyze, maintain and distribute data necessary to maximize all recovery and reconciliation efforts.

  • Oversees and directs all vendor relationships specific to recovery activity.

  • Directs management in the development and implementation of policies and procedures that safeguard the company against fraud and overpayments.

Education:  Bachelor's degree required, Master's preferred.        

 

Experience:  5 - 7 years experience with hospital or physician billing, collections and vendor management.  Prior managed care or insurance industry experience preferred

 

Technical Skills/Requirements: 

Proficiency in Microsoft Office software applications and relational databases

Demonstrated leadership and motivation skills

Solid knowledge of capitation arrangements, coordination of benefits, subrogation and recoveries.
Post Date:  02/13/2012

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