Refund Specialist (Credit Balance Reconciliation)

• 2 years of experience in Accounts receivable, medical collection, and credit balance refund processing experience.
• Working knowledge of medical insurance and recoupment processing preferred.
• At least 1 year of recent experience in a medical office / RCM.

• Answer patient and insurance questions regarding refunds and credit balances.
• Assist on refund issues.
• Utilize online payment platforms to process patient refunds.
• Print & analyze a credit balance report on a monthly basis.
• Review & analyze a payment unallocated account on a monthly basis.
• Maintain a high level of accuracy and efficiency regarding data input & account balance determinations while achieving minimum goal of 50 (fifty) account reviews daily.
• Accurate and thorough account balance research and refund/reconciliation.
• Research and recoupment processing to insurance carriers.
• Generate correspondence to patients and/or insurance, to facilitate credit balance reconciliation.
• Billing systems, Royal EMR, RightFax, and carrier websites to extract EOBs or zero pay EOBs for account reconciliation processing.
• Submit appeals in accordance with billing office policies and procedures.
• Receive and organize all incoming correspondence and EOBs.
• Data entry of returned check amounts and facilitating collection of returned check amounts.
• Ensure all responses to incoming correspondence and EOBs are processed within 48 hours of receipt.
• security of patient information in accordance with the Privacy Act of 1974 and the Health Information and Portability Act (HIPAA).
• Work with Accounting Department for unclaimed property refund processing.

Knowledge, Skills, and Abilities:

• Knowledge of insurance contract language and reimbursement methodology.
• Working knowledge of the Fair Debt Collection Act and state and federal laws applying to collection activities.
• Excellent verbal and written communication skills, interpersonal skills, analytical skills, organizational skills, math skills, accurate typing, and data entry skills.
• Treat all patients, referring physicians, referring physicians' staff, and co-workers with dignity and respect. 
• Knowledge of all confidentiality requirements regarding patients and strict maintenance of proper confidentiality of all such information.
• Knowledge of medical terminology, CPT and ICD-10 coding, office ethics, and spelling.
• Must possess knowledge and understanding of managed care and insurance practices.