Summary:

• Responsible for Financial Recovery (including Recovery Vendors) and Coordination of Benefits for the organization.
• Collaborate on strategic planning and provide oversight of development and implementation of best practices; establish and then maximize probability for successful achievement of goals and metrics; provide leadership across and with various
  internal and external business partners.
• Build relationships with Enterprise provider network (PNM) leaders: Operations, Claims, PFO, Configuration, IT, Medical Economics, etc. across the organization to develop and operationalize recovery and coordination of benefits efforts.
• Partner with organizational leads to influence provider satisfaction by implementing projects and best practices around our policies and financial recovery practices.
• Oversee SLA's specific to our relationship with CTS; ensure full compliance for state or federal regulations relative to proper financial recovery activities.

Accountabilities:

• Direct all claims payment recovery activities (subrogation, credit balances, payment errors, etc.) to meet established financial targets.
• Responsible for oversight and maintenance of all internal and vendor related workflows and all financial reporting requirements.
• Responsible for the direction of all Coordination of Benefits (COB) activities for the organization including oversight and maintenance of all internal and vendor related workflows.
• Responsible for the direction of the recovery and collections vendor program for the organization. Identify and establish additional recovery vendor relationships in any other "gap areas" of pre- and post-payment claim recovery.
• Utilize vendor data to identify opportunities to insource processes/functions where appropriate.
• Daily oversight of the Cognizant vendor Financial Recovery and Coordination of Benefits activities; provide feedback to the vendor in support of these activities.
• Responsible for development of an SLA review program.
• Partner with Operations, Payment Integrity, and IT to identify opportunities to improve our processes, our human & technological capabilities in support of reduction of the occurrence of overpayments, and our ability to recover
  overpayments which do occur.