Recovery / Resolutions Analyst Cover Letter

In response to your job posting for recovery / resolutions analyst, I am including this letter and my resume for your review.

In my previous role, I was responsible for assistance to individuals by securing information regarding their submitted complaint and interpreting GCU policies and procedures or regulatory guidelines to determine the nature of the complaint.

Please consider my qualifications and experience:

• Evaluation and Management Knowledge and Experience
• Experience with recoveries and payables on Subrogation Claims
• Production environment experience
• Medical record familiarity
• Valid, active and unrestricted RN license
• Proficiency with the Microsoft Office Suite (Word, PowerPoint, Excel - create/edit/save documents, and Outlook- email and calendar management)
• Certified Coder AHIMA or AAPC Certified coder
• Knowledge with at least 1 claim platform or similar operating system technology

Please consider me for the recovery / resolutions analyst opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for analysis expertise on regular reviews of internal processes and activities ensuring adherence to division, entity and regulatory guidelines;.

Please consider my experience and qualifications for this position:

• Identifies overt billing trends, waste and error identification, and recommends providers to be flagged or filtered for review
• Provides clinical explanation both to the provider and client in case management systems
• Analyze/research/understand how a claim was identified by Payment Integrity and determine appropriate resolution path
• Work with applicable business partners to obtain additional information relevant to the Payment Integrity case in order to drive resolution (e.g., Network Management, Claim Operations, OGS, UCHPI)
• Comprehend and adhere to applicable federal/state laws and regulations (e.g., DOI, ERISA, HIPAA, CMS)
• Work with key matrix partners (e.g., provider advocates, Network Management) to facilitate resolution via telephone and WebEx meetings
• Conduct/utilize investigations to determine accuracy of claims payments (pre-pay)
• Partner with UnitedHealthcare to review claim information and identify issues related to payment accuracy

Please consider me for the recovery / resolutions analyst opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for regulatory support for admitted and surplus lines and ensure all business units are compliant with all regulatory guidelines.

My experience is an excellent fit for the list of requirements in this job:

• Microsoft Office Suite (SharePoint, Excel, PowerPoint, Outlook)
• Understanding of healthcare compliance/regulatory environments
• Six Sigma experience/ Lean experience
• Knowledge of managed care and government operations/products
• Knowledge in SQL/Macros/databases/IT Certifications
• Intermediate level of Microsoft Excel (data entry, sorting/filtering, pivot tables)
• Valid, active and unrestricted RN license or Certified Coder, such as AHIMA, AFAMEP, AAPC or Certification (CPC, CCS, CCA, RHIT, CPMA, RHIA or CDIP)
• Moderate level of Microsoft Excel (data entry, open, create, save, and edit spreadsheets)

I would like to submit my application for the recovery / resolutions analyst opening. Please accept this letter and the attached resume.

Previously, I was responsible for strong leadership to subject matter experts, regulatory teams, and other external business partners to improve provider resolution processes and guidelines.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Shapes policies and guidance utilized during disruptions and irregular operations
• Help manage the daily activities of Outreach Operations by coordinating work assignments and staffing as needed
• Investigate and resolve overpayments on all claims types, assist in resolution for health plans, commercial customers, and government entities as needed
• Triage claims data to send for medical coding review
• Assist the prospective team with special projects and reporting
• Investigate, review and provide clinical and/or coding expertise in a review of post-service, pre-payment or post-payment claims
• Interpretation of state and federal mandates, billing practices/patterns, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with overt billing patterns and make recommendation decisions based on findings
• Provide coaching and education to reduce errors and improve client survey scores

I am excited to be applying for the position of recovery / resolutions analyst. Please accept this letter and the attached resume as my interest in this position.

In my previous role, I was responsible for guidance and expertise for components and internal policies and processes to assure regulatory compliance and quality systems are maintained.

Please consider my experience and qualifications for this position:

• Achieve applicable targets/metrics (e.g., production targets, financial targets, quality targets)
• Research provider and health plan information, determine if criteria is met and set up potential quality of care grievances
• Ensure adherence to state and federal compliance policies and contract compliance