Refunds Specialist I - REMOTE

Job Summary

Processes refunds to patient and insurance accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Supports in the reconciling, correction, and/or completion of contractual adjustments, insurance refunds, and patient refunds. Responsible for Web based discrepancy refunds and RN lines to logging system. Is flexible in work priorities and performs other duties as assigned.

Essential Functions

• Processes refunds to patient and insurance accounts.
• Maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors.
• Work overpayments, request for refund letters, faxes and telephone requests.
• Utilizes various computer systems and databases to complete analyze accounts.
• Reviews daily Credit Balance reports to analyze issues causing credit balances. Corrects contractual adjustment amount, if needed. Compiles refund request with appropriate documentation, if applicable.
• Ensures compliance procedure for prompt recording/processing of all refunds.
• Communicates any refund issues with Reimbursement Manager/Supervisor as needed.
• Answer questions via email from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, and account discrepancies.
• Statutes Government credit for reporting to Corporate.
• Identifies accounts to be escheated to the state.
• Monitors accounts for State Statue Waiting Period.
• Researches credit balance accounts to determine if a payor or patient has overpaid on the account.
• Prices claims using contracts, pricers, and payment methodologies to validate refund requests from payors.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• 1-3 years accounts receivable experience in hospital or medical setting required
• 1-3 years experience working with Managed Care Contracts preferred and Federal programs preferred

Knowledge, Skills and Abilities

• To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software.