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 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
- 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
