Refund Specialist: Insurance Claims

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Job description

Description:

Schedule: Hourly Monday- Friday 8 hour shift, 40 hours per week (includes a clocked out 30 minute lunch every day) - OT not available except upon Leadership approval for special circumstances/projects

First 120 days:

PST: 8 am - 4:30 pm

MST: 8:30 am - 5 pm (7:30 - 4 PM PST)

CST: 8:30 am - 5 pm (6:30 am - 3 pm PST)

EST: 9 am - 5:30 pm (6 am -2:30 pm PST)

120 days subject to change based on approval and meeting metric and performance expectations autonomously

Client is currently looking for a Refund Specialist for our Credits Team in our Revenue Operations Department. Individuals who excel in this role are highly ambitious, results driven, and willing to 'think outside the box.' This position requires a high level of attention to detail and the ability to work well as part of a fast paced team. The ideal candidate has a high level of multitasking abilities, strong mathematical and analytical skills, and is driven by resolving open balances with the goal to prevent future rework. In this position, you will analyze EOBs and/ or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and request adjustments. You will effectively identify trends and analyze root causes to drive work efficiently within the team. Hybrid and remote position available. All necessary equipment is provided.

Qualifications:

Strong Refund experience required, 4+ years hands on experience.

High School Diploma or equivalent required

Healthcare and medical claim overpayment remediation and refunding experience is required

2-4+ years' experience with accounting, transactions, or medical billing/accounting systems required

Knowledge or experience working with a variety of health care insurance payers is preferred

Intermediate computer proficiency in Microsoft Office including Excel and Outlook- required

Essential duties and responsibilities:

Autonomously research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances (claim(s) paid more than expected by payer); actions included but not limited to initiating refund packets, retractions, and/or adjustments to claims

Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims

Use critical thinking, root cause analysis, and problem solving skills to resolve issues on outstanding claim balances

Uses strong organizational skills to effectively manage large amounts of detailed information

Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances.

Contributes to implementation of process improvement initiatives aimed at improving credit department

Ensures compliance by using established internal control procedures by examining records, reports, operating practices, and documentation

Stay current on communications relating to healthcare reimbursement and regulatory changes

Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and Client policies

Understand and adhere to all policies, laws and regulations applicable to this role

Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position

Participate in group settings and team work environment

What We'll Provide:

All necessary workstation equipment

• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.

Benefits:

For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website .

California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here .

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department .

Rose International has an official agreement (ID ), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

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