Refund Specialist - Conway, United States - Conway Medical Center

Description

Position Summary:

Each employee who participates in the coding, billing or claims submission process, from the initial receipt of a physician order to the receipt of payment for services, shall accurately and honestly perform his/her functions to ensure that accurate claims are submitted, and the organization retains only those funds to which it is legally entitled.

The Refund Specialist- PNS (RS) will be responsible for the complete credit balance, aged trial balance, as well as the investigation and resolution of the credit balance accounts for Provider Network Services. The RS will also be responsible for any refund request made by third party payors or patients. The RS will research each credit balance and apply any credits to existing balances due before considering refunding the paying source. The RS will work closely with the Patient Account Representatives for the credit account so that all allowances and balances will be verified before any refund is issued and all documentation supporting the refund will be printed copied and attached to a refund request sheet for the approval of the Director Revenue Conway Physicians Group. Other responsibilities include contacts appropriate personnel to obtain additional information/clarification regarding past due bills, follows up on problem credit balances and develops recommendations for their proper disposal, works the credit balance aged trial balance with the goal of reducing the total amount prior to month end and handles the mail and phone refund request.

All organizational staff, including this position, are specifically required as a condition of continued employment to make advance preparations for their families and pets in the event of weather emergencies such as Hurricanes and flooding threats. Any staff member can be determined as essential staff required to report to the main facility during these events. In many cases this means reporting and sleeping at the facility before, during and after a weather emergency. By signing this job description, the staff member accepts this responsibility of readiness to report to work during any designated emergency staffing situation. CMC staff members operate as one team meeting the healthcare needs of our communities, thus this position will on occasion complete other duties as assigned beyond those designated in this primary job description which may include "float" coverage at an alternate facility, department or assignment.

Qualifications

Assessment of overall credit worthiness by review of a consumer credit report is required.

Education:

• High school diploma required.
• Associates degree in business related field preferred.

Experience:

• Minimum two (2) years' experience in insurance processes and billing guidelines and regulations required.
• Prior billing experience in a physician office preferred.

Special Skills:

• Exemplary core customer service skills strongly required.
• Strong organizational skills.
• Strong PC skills required.
• Strong verbal communication skills required.
• Strong verbal and written communication skills required.

Working Conditions:

• Stress level high due to multiple demands frequently occurring simultaneously.
• Physical surroundings pleasant and comfortable
• Generally contained office type environment
• Most work performed while sitting, however, a moderate amount of walking and moving around within a confined area occurs

Physical Requirements:

Light-Medium - While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Ability to hear to process instructions and safety code and alarms required. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and will be assessed by post offer Employee Health fit-for-duty review.