Description:
The Hospital Refund Specialist has the responsibility of identifying and resolving credit balances on patient accounts to ensure refunds are issued in a timely manner. This position ensures the highest quality and safe delivery of customer service, maintain compliance with professionalism and regulatory processes. Interface with facility clients and internal corporate stakeholders.
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Manage daily work queues of credit balances for both onshore & offshore teams.
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Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances.
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Complete thorough review of patients’ accounts with credit balances to validate the patient overpayment is accurate.
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Recommend an adjustment when applicable or recommend a refund of the overpayments to the insurance carrier or patient, providing the appropriate documentation.
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Apply knowledge related to insurance contracts, interpret explanation of benefits, understand regulations concerning coordination of benefits and other applicable guidelines.
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Process refunds accurately and in timely manner adhering to contract language where appropriate.
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Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims.
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Use critical and analytical problem-solving skills to resolve issues
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Uses strong organizational skills to effectively manage large amounts of detailed information
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Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, surgery centers, and payer representatives to resolve credit balances.
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Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
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Other duties as assigned
Requirements:
- High school graduate or equivalent.
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Must have the skills necessary to operate the office equipment required to fulfill job duties
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Excel, Word, Outlook
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Able to navigate through nThrive and Availity (preferred)
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Previous credit balance resolution experience in a facility or CBO environment
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2 years combined experience CBO in Billing, Cash Collections, Denials, Disputes, Follow-up, and/or appeals
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Understanding of medical terminology
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Basic understanding of credit and refund guidelines