Refund Specialist

Purpose

Performs all duties required to ensure accurate distribution of patient/insurance payments and appropriate adjustments to patient accounts. Carries out all duties while respecting patient confidentiality and promoting the mission and philosophy of the organization supported.

• Audits patient accounts to resolve all credits and undistributed activity.
• Thoroughly researches and resolves all credits as assigned through daily distributions and reports.
• Reviews carrier explanation of benefits to determine accurate reflection of carrier, provider and patient responsibility.
• Opens payment posting or adjustment batch to perform appropriate account maintenance activity to appropriately balance claim activity.
• Accurately distributes or redistributes payments and adjustments to correct invoice and date of service.
• Generates any adjustments necessary to complete correct posting of payments and adjustments using appropriate A/R and ANSI codes.
• Ensures accurate transfer of outstanding balances to next responsible party as indicated by payer explanation of benefits.
• Assists with training of new employees.
• Compiles and submits patient and insurance refunds according to established policy and procedure with all supporting documentation.
• Reviews and files all secondary insurance claims attaching carrier explanations of benefits for designated plans.
• Completes clear and accurate account notes to document issue, source and resolution of all account maintenance activity.
• Obtains supervisor signature on all large dollar write-offs according to established policy.
• Follows established guidelines to complete all report activity to meet month end deadlines.
• Documents daily performance in weekly productivity log.
• Researches and processes patient credit card refunds in Epic.
• Distributes daily credit batches to staff.
• Assists and processes Agency notifications.
• Efficiently and effectively maintains work queues to perform necessary account maintenance processes according to established policy and procedure.
• Utilizes all payer web site systems & tools to obtain accurate patient eligibility and claim payment details.
• Attends meetings as requested.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Maintains regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.

• Keeps complete, accessible, dated files.
• Identifies training needs of the Team and works with the Team Leader and Supervisor to provide support.
• Aids coworkers as requested and/or necessary.
• Provides workload statistic reports to management team.
• Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources, i.e., provider or management team.
• Attends required in‑services/training.
• Assists with training staff.
• Performs other duties as assigned.

Education: High school diploma or GED equivalent.

• Require at least 1–2 years of related experience working with medical billing in a practice facility setting.
• Preference for knowledge of computer data processing systems.
• Preference for knowledge of and experience in ANSI denial codes.
• Preference for knowledge of and experience in effective use of CPT, ICD‑9 and HCPCS coding.
• Ability to sit for extended periods of time at a computer workstation.
• Preference for knowledge of legislative and private sector third party regulations and guidelines.
• Excellent verbal and written communication skills to communicate clearly and effectively to all levels of staff and the public.
• Accurate ten‑key by touch.
• Basic knowledge of accounting and banking practices.

• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities.
• Ability to always perform job duties in a professional manner.
• Ability to understand, recall, and communicate information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job duties.
• Ability to focus on win‑win communication when conflicts, problems or misunderstandings arise.
• Ability to organize and prioritize own work schedule.

Monday – Friday 8:00 am – 5:00 pm

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