Recovery Specialist
Sanford Health
Summary
The Recovery Specialist is responsible for the identification and research of third party claims. Works for the recovery of overpayments involving workers compensation, no-fault, hospital liens, and any other type of accident or liability claims. Identifies legal liability, and pursues, negotiates, and settles subrogation, liens, and reimbursement recoveries.
Job description
Summary
The Recovery Specialist is responsible for the identification and research of third party claims. Works for the recovery of overpayments involving workers compensation, no-fault, hospital liens, and any other type of accident or liability claims. Identifies legal liability, and pursues, negotiates, and settles subrogation, liens, and reimbursement recoveries.
Job Description
Applies applicable laws, regulations, and policy language to achieve recoveries in accordance to mandates. Negotiates lien settlements with attorneys and other responsible representatives to obtain maximum recovery.
Assists in response to Summons and Complaint and interrogatories from attorneys where suit has been commenced. Communicates legal rights to all involved parties placing them on notice of lien. Reviews medical charges to identify relatedness. Maintains detailed recovery records to ensure case facts are accurate.
Maintains a high level of technical skill and knowledge of recovery processes to act as a resource to the department. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions.
Qualifications
Associates degree in business, legal, or healthcare related field required. In lieu of education leadership may accept three years’ applicable work experience.
Minimum of one year work experience with coding, insurance processes, liability, subrogation, coordination of benefits or workers' compensation claim adjudication.
CSRP (Certified Subrogation Recovery Professional) designation from NASP (National Association of Subrogation Professionals) preferred.
Requirements
- Associates degree in business, legal, or healthcare related field required
- In lieu of education, three years applicable work experience accepted
- Minimum of one year work experience with coding, insurance processes, liability, subrogation, coordination of benefits or workers' compensation claim adjudication
- CSRP (Certified Subrogation Recovery Professional) designation from NASP preferred
Company overview
Sanford Health is one of the largest integrated healthcare delivery systems in the United States, operating as a nonprofit organization headquartered in Sioux Falls, South Dakota. Founded in 1894, the organization has grown into a comprehensive health system with 44 medical centers, 482 clinics, and more than 200 senior living facilities across 26 states and nine countries. Sanford Health provides a full spectrum of healthcare services including acute care hospitals, specialty clinics, senior care through the Good Samaritan Society, genomic medicine, global clinics, and the Sanford Health Plan insurance program. The system employs over 48,000 healthcare professionals including 1,400 physicians and delivers care through five Centers of Excellence: Cancer, Children's, Heart, Orthopedics/Sports Medicine, and Women's Health. Annually, Sanford Health handles approximately 5.3 million outpatient visits, 84,000 admissions, and 136,000 surgeries. The organization is also actively involved in medical research and education through partnerships with academic institutions, positioning itself as a regional healthcare leader in the Midwest with expanding international presence.