The Refund Specialist-Insurance is responsible for reviewing accounts, identifying insurance overpayments and credit balances, as well as evaluating and verifying refunds are issued in accordance with current policies and procedures.
Duties & Responsibilities
Review refund and over payment requests from insurance payers to determine if over payment has occurred
Review and resolve credit balances through credit transfers, account corrections and refund request form completion for manual refund check requests
Identify root causes and trends contributing to patient and insurance credit balances
Proactively work with other revenue cycle departments to improve efficiency and reduce and/or eliminate refund issues
Posts debits for approved refunds
Research returned checks and collaborates 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
Develop and maintain expertise with payer specialty-specific payment policies
Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
Preform special projects as required
Qualifications & Competencies
BA/BS in accounting, business, finance or an equivalent combination of training and experience is necessary
3 years'+ experience in health care /managed care environment, preferably in a large physician practice or a combination of experience and education
1 year+ of experience with complex refunds to insurance
Knowledgeable in physician reimbursement and managed care claim payment issues.
Excellent communication skills and ability to effectively communicate with various levels of management in a multi-disciplinary environment
Understanding of electronic medical record and billing system Pricing Module and fee schedules
Strong analytical skills with attention to detail
Advanced level Excel and financial analysis related to physician reimbursement
Ability to do math calculations, input data into the computer, and analyze data as requested.
Must be willing to work onsite in Ortigas, Pasig City
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