The Refunds Specialist 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 overpayment requests from insurance payers to determine if overpayment 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
- At least 6 months direct experience working in Epic’s billing modules (Epic Resolute PB or Epic Resolute HB)
- 2+ Years US Health Insurance billing, posting, and adjusting claims
- 2+ Years in a US healthcare billing office, managing patient credits and insurance adjustments
- 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
