Refund Specialist - Dallas, TX
3 hours ago
Job description
Job Description
Resolves complex issues, codes, and posts entries into accounting systems to ensure accurate and expedient processing of general accounting, accounts payable, accounts receivable or other financial documentation.
RESPONSIBILITIES
- Reviews all refund requests from patients and third party payors and credit balances, analyzes the account payment history, determines validity of the request and responds and/or processes refund in a timely manner. Audits patient accounts to find and correct complex refund issues.
- Alerts the Refund Supervisor of any trends in credit balances that may result from payor overpayments and/or inappropriate payment and adjustment posting.
- Monitors all credit balances for Medicaid, Medicare and other State and/or Federally funded payors and processes corrections immediately to ensure no credit balances remain unresolved.
- Answers questions and provides appropriate guidance to lower level members on resolving complex account and payor issues.
- Identifies ways to improve work processes and provides recommendations for new or revised procedures, collaborates with the Supervisor to develop tools to enhance the collections process. Implements and monitors results as appropriate in support of the overall goals of the department and PHHS.
- Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
- Tracks productivity and provides cumulative reports daily, weekly or monthly, as required by the supervisor and/or manager.
JOB ACCOUNTABILITIES
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Requirements
- Must have five (5) years experience in accounting or business office environment - [REQUIRED]
- Must have four (4) years experience of payment posting, billing, and/or collections - [REQUIRED]
- Must be able to communicate effectively with insurance companies - [REQUIRED]
- Must be able to resolve complex accounting issues related to multiple groups (3rd party payors, physicians, patients) - [REQUIRED]
- Must have working knowledge of medical software - [REQUIRED]
- Completion of sixty (60) hours of college with an emphasis on Accounting - [HIGHLY PREFERRED]
- Basic medical terminology knowledge - [PREFERRED]
- Bilingual skills - [PREFERRED]
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