Auditor - Provider Recovery

Schedule: Hybrid schedule - remote work on Monday and Friday, and onsite presence Tuesday through Thursday.Description:The Provider Recovery Auditor is responsible for auditing and recovering claims overpayments, including the coordination of benefits (COB) and third-party liability. This role supports organizational quality initiatives and ensures compliance with claims processing guidelines, contractual agreements, and regulatory standards within a managed care environment.What You Will Do:Identify and expand recovery opportunities through audit findings, provider outreach, third-party liability, and CCS eligible servicesConduct audits of payment errors and process provider refund checks while determining root causeReview claims processing outcomes to ensure accuracy and proper application of fundsRespond to provider inquiries and disputes related to refund requests using claims guidelines, contractual terms, and regulatory requirementsInterpret Division of Financial Responsibility (DOFR) and payment methodologiesCollaborate cross-functionally to support recovery efforts and maintain strong internal partnershipsContribute to quality initiatives aligned with HEDIS, CAHPS, and NCQA standardsYou Will Be Successful If:You demonstrate strong analytical thinking and can identify root causes of payment discrepanciesYou are comfortable working with large datasets and performing detailed auditsYou can clearly communicate complex claims and financial information to providers and internal teamsYou proactively identify recovery opportunities and recommend actionable solutionsYou maintain accuracy and compliance in a fast-paced managed care environmentWhat You Will Bring:Four years of claims processing experience, including Medicare and Medi-CalTwo years of claims auditing experience in a managed care environmentExperience interpreting contracts and financial DOFRProficiency in Microsoft Office, especially Excel for data analysisStrong written and verbal communication skillsAbility to analyze issues, assess impact, and provide practical solutionsAbout Impresiv Health:Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.That s Impresiv!