About this role
Role Overview
- Reviews refund/overpayment requests from insurance payers to determine if an overpayment has occurred
- Reviews and resolve credit balances through credit transfers, account corrections and refund request form completion for manual refund check requests
- Identifies root causes and trends contributing to patient and insurance credit balances and works collaboratively with all areas of the revenue cycle to improve efficiency and eliminate these issues
- Posts debits for approved refunds
- Research returned checks and collaborated with A/P for reporting to unclaimed property
- Resolves Department credit balance inquiries for transfers and refund check requests
- Ability to work collaboratively and build positive business relationships with clinical areas and the payer community
- Understanding of electronic medical record / billing system Pricing Module and fee schedules
- Develops expertise with payer specialty-specific payment policies, by using the payer assigned websites
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
Requirements
- Bachelor’s degree in accounting, Business, Finance, or a related field, or an equivalent combination of education, training, and experience
- Minimum of 3 years of experience in a healthcare or managed care environment, preferably within a large physician practice
- At least 1 year of experience handling complex insurance refunds
- Strong knowledge of physician reimbursement methodologies and managed care claim payment processes
- Advanced proficiency in Microsoft Excel and financial analysis related to physician reimbursement
- Strong analytical skills with exceptional attention to detail
- Ability to provide clear, professional verbal feedback
- Ability to follow and understand instructions and respond appropriately in various work situations
- Demonstrates mental adaptability and flexibility when working with diverse individuals and changing priorities