High School Graduate.
Typically requires 1 year of experience in healthcare business office setting.
Good organizational ability and communication skills (written and verbal).
Ability to read, enter and retrieve information from multiple patient accounting systems.
Basic understanding of Microsoft Office
Basic bookkeeping skills and a strong mathematics aptitude.
Able to work independently, under pressure in a fast paced environment.
Strong attention to detail and maintains high degree of accuracy.
Managed Care payer contract terms and Medicare/Medicaid payer guidelines.
Regular and reliable attendance.
Physical Requirements and Working Conditions:
Must be able to sit the majority of the workday.
Exposed to a normal office environment.
Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
The Refund Rep I will work with peers to maintain credit balances at a minimum. Responsible for taking the appropriate action necessary to assure resolution of the credit balance is achieved. Accurately resolves all credit balances that are identified to require a Refund/Adjustment to the patients and insurance company by processing all Refund/Adjustment batches timely and efficiently, following Refund/Adjustment policies and procedures. Contribute to collaboration, integration and performance improvement activities with revenue cycle and clinical operations teams to achieve strategic, financial, and operational performance goals. The Refund Rep I will understand basic concepts of managed care contract terms and basic understanding of Managed Medicaid and Managed Medicare resulting in appropriate routing of credit balances for accurate resolution, determination and reporting of trends for root cause resolution. Refund Rep I should work well independently with minimal oversight.
Responsible for analyzing and resolving credit balances and requests for refunds within all AAH Hospital Billing entities and Professional Billing within multiple patient accounting systems and ensure appropriate contract reimbursement calculation rates are applied.
Utilize multiple systems to review credit balances as assigned to determine the appropriate course of action needed to accurately resolve.
Determine payor creating overpayment credit, verify coordination of benefits, reimbursement calculations and payment source and follow the appropriate system process and department procedures to resolve.
Identify and report root cause of credit balances and payer refund trends partner with internal and external counterparts.
Document patient account notes and Guarantor account notes with all actions taken to resolve credit or refund requests.
Possess knowledge of the Refund/Adjustment processes and utilizes systems/applications proficiently in order to resolve credit balances and process refunds appropriately. Contribute to improvement initiatives and department/system goals.
Adheres to established Advocate Aurora Health Revenue Cycle policies, procedures, guidelines and productivity standards and responsible for maintaining personal growth and development.
Responsible to read and understand all AAH Revenue Cycle policies and departmental policies and procedures.
Assists level II’s in completing ad hoc projects.
Tagged as: USA
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