Refund Specialist

POSITION PURPOSE

• Prepares and submits properly executed claims to appropriate third-party payers on a timely basis while ensuring payer-specific billing requirements are met. Reviews and refunds accounts where appropriate. Reviews accounts and requests for recoupments, approves and tracks status, following the appropriate workflow. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts, as necessary. Performs other related duties as requested.

MINIMUM EDUCATION REQUIRED

• High School or Equivalent (GED)

MINIMUM EXPERIENCE REQUIRED

• Must have at least six (6) months of hospital billing experience.

LICENSES / CERTIFICATIONS REQUIRED

• N/A

KNOWLEDGE, SKILLS & ABILITIES REQUIRED

• Ability to read, write, hear, speak and comprehend the English language.

• Requires exceptional communication skills and the ability to deal with people in all levels of society in a calm, courteous manner.

• Ability to handle fluctuating daily work assignments based upon changes in patient census volume.

• Business Office experience in a health care environment in Billing, Customer Service, insurance follow-up or Collections is preferred.

• Knowledge of telephone etiquette; typing; microfiche reader; computer; calculator; copy machine; Internet; and the use of a fax machine. 

• Ability to walk, sit, stand, bend, push, and lift weights of up to 25 pounds for up to 5% of the workday.

PRINCIPLE ACCOUNTABILITIES AND ESSENTIAL DUTIES

• Independently performs all aspects of insurance precertification, claims billing, follow-up work, and appeals, including accessing, retrieving, and inputting information throughout the claims processing cycle.

• Positive communication skills, ability to successfully interact with all patients and staff including, proper display of telephone etiquette.

• Continually demonstrates courteous, cooperative and service-oriented manner following hospital policies.

• Performs clerical functions while maintaining current accounts accurately and timely; utilizing computer, calculator, copier, fax machine and Internet knowledge. Owns a complete understanding of the billing software application. 

• Effectively keeps current on billing guidelines, memos, correspondences, reports, and work queues.