Refund Specialist

Overview:

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

OCCUPATIONAL SUMMARY

Processes payor correspondence and refund requests through extensive phone, fax, and written correspondence with the payors and pricing agencies.   Ensures correct reimbursement rates based on current client contracts and responds to payor requests in a timely manner. Utilizes knowledge of the revenue cycle and patient accounts to maximize productivity. Abides by and promotes HIPAA compliance at all times.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Contacts insurance companies to follow up on correspondence and refund requests.  Holds payors accountable for timely response and resolution of all correspondence.
2. Utilizes/reviews account information from all available sources; online data, hard copy reports, referral forms, UB/HCFA and EOBs to fully discuss condition with the payor via phone, fax or email.
3. Ensures correct reimbursement rates are reflected in refund requests.
4. Requests approved refunds from the client through proper channels.
5. Refers accounts to the appropriate departments for necessary action, ie balance transfers, coding review, remit posting, etc.
6. Maintains appropriate and accurate system documentation with notes and standard note codes.
7. Notifies Supervisor of payor trends within the correspondence.
8. Submits written summary of trends and denials to Supervisor on a monthly basis.
9. Performs Physician Denial Management responsibilities and provide back-up as needed.

REQUIRED:

1. 1 year insurance collections/ AR receivables experience or 2 years of customer service/ banking/ accounting experience
2. Good verbal and written communication skills.
3. Basic computer skills, including the Microsoft Office Suite
4. Basic reading, writing, and arithmetic skills

PREFERRED:

1. Knowledge of healthcare receivables and collections, including denial and appeal processes.
2. Understanding of the healthcare revenue cycle
3. Coding knowledge or CPC certification
4. Knowledge and ability to use insurance company websites