Employer: Change Healthcare
Overview of Position
The Refund Specialist/ Credit Resolution Representative is primarily responsible for monitoring and resolving credit activity that is housed in credit work queues as well refund request letters received from governmental and commercial carriers. This individual reviews the specifics regarding charges, accuracy of reimbursement to expected reimbursement and how that payment was posted to the billing system to determine if a true credit exits. If a refund is required, the Credit Resolution Representative will perform the appropriate steps in the billing system to generate the refund. The Credit Resolution Representative also, looks for trends that exist and the root cause for credits and works with the appropriate parties to minimize refunds. The Credit Resolutions Representative reports to the Manager of Payment Applications.
What will be my duties and responsibilities in this job?
- Research credit balances on patient accounts.
- Make posting corrections as necessary.
- Research and post refunds appropriately in patient accounting system.
- Determine the correct course of action to resolve the refund request or credit balances
- Work closely with third-party payors throughout the refund and credit issue resolution processes.
- Maintain knowledge of insurance payments and rejection/denial processing.
- Update credit balance/refund work queue as necessary.
- Utilizes all available resources (EOBs, IMAGENOW, payor websites, Availity, Navinet) to ensure refunds/take-backs (recoupments) are adjudicated correctly.
- Notifies payor representative to initiate take-back (recoupment), and provides support documentation as required to the payor representative.
- Provides all required documentation necessary for refund approval.
- Prepares approved refund requests and submits to Team Lead for review and in turn submission to finance for reimbursement.
- Updates billing system to ensure that refunds/take-backs are properly documented. Identifies all misallocated reimbursement for proper disbursement.
- Ensures complete, accurate, and timely account notation and documentation in the Revenue Cycle systems, including adjudication and denial processing. Daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.
What are the requirements needed for this position?
- 3+ years of working with patient accounts
- High Diploma
What other skills/experience would be helpful to have?
- Ability to work independently; prioritize work and results oriented.
- Excellent written, verbal communication and interpersonal skills.
- Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
- A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
- Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.
- Experience working with refunds
- Advanced understanding of payment methodology for Physician services.
- An understanding of CPT, ICD-9, HCPCS.
- An understanding of contract terms and payer policy.
- Clear understanding of the impact payment applications and refund/credit processing has on Revenue Cycle operations and financial performance.
- Must possess a strong math aptitude.