Refund Analyst

Description

Company Overview

National Partners in Healthcare (NPH) is a progressive healthcare company specializing in anesthesiology. We partner with physicians and health systems to deliver high quality care, aligning synergies and best practices to achieve superior outcomes. As a leader in the industry, we believe in developing a foundation of trust, transparency, and excellence in everything we do. The success of our company has created excellent career advancement opportunities that support a healthy work/life balance.

Position Summary

The Refund Analyst reviews all insurance carrier refund requests for accuracy and resolves these requests.  This included interpreting and applying reimbursement policies such as contracted fee schedules and multiple procedure discounts, as well as, contracting insurance carriers and/or patients to obtain addition information about the claim.  In addition, the Refund Analyst appeals invalid refund request or approves valid request. 

Essential Duties and Responsibilities

• Daily interaction with insurance companies, patients, coworkers and other departments about insurance payments and refunds in a medical billing environment
• Completes necessary forms and assembles information correctly to clear credit balance from Accounts Receivable
• Analyze credit balances to determine the appropriate action
• Resolves credit balances in accordance with guidelines. Logically determines who rightfully should receive the refund
• Reviews the master rate sheet for rate verification  change to current managed care grid
• Expedites request for patient refunds in a timely manner.  Collates refund checks with refund letters to promote better communication with the patient.    requests
• Posts allowed adjustments as needed to assigned accounts
• Reviews accounts and determines if a credit is a patient or insurance refund
• Receive and process patient and insurance credit request from various sources (patients, CBO staff, insurance companies)
• Moves credits to satisfy debits
• Batch and balance refunds
• Independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion
• Accurately post or record information regarding collection receipts
• Processes and files information regarding collection receipts
• Document all accounts accordingly
• Completes special projects and tasks by the agreed upon timeframe and proactively informs Supervisor/Manager of any barriers or delays
• Provide high level of customer service while maintaining a high level of confidentiality and discretion. 
• Demonstrates in depth knowledge of established AF follow up procedures and guidelines, including applicable government regulations.  – I don’t know what this is supposed to be
• Works credit work queues daily and analyzes credit balances based on the days on work queues, as well as, review of high dollar accounts in a timely and efficient manner.
• Adhere to all company policies and procedures.
• Adherence to and compliance with information systems security is everyone’s responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered.  Report information systems security problems.

Non-Essential Duties and Responsibilities:

• Performs other duties as assigned.

Qualifications

Education/Licensing/Certification:

• High School graduate or equivalent.

Experience:

• Minimum of (3) three years experience in a healthcare business office, specifically collections and/or payment posting, is required.
• Experience with reading and interpreting the managed care contracts terms
• At least (2) two years experience related to insurance appeals

Knowledge and Skills:

• Knowledge of organization policies, procedures and systems.
• Ability to provide excellent customer service
• Knowledge of regulatory requirements concerning credit balances for patient and third-party payers
• Ability to identify debits and credits
• Ability to read and understand insurance EOBs.
• Ability to think critically to skillfully gather and analyze information to resolve problems
• Solid knowledge of medical coding, including CPT, ICD-10, HCPCS and insurance claim processioning of professional and facility claims
• Skill in verbal and written communication.
• Ability to work effectively with staff, physicians and external customers. Must display teamwork attitude and good inter personal skills.
• Must have a pleasant disposition and high tolerance level.
• Ability to work independently with limited supervision.
• Must be proficient in Microsoft Office (Excel, Outlook, Word), electronic medical records (EMR), medical practice software and internet applications.
• Basic knowledge of managed care programs and billing requirements necessary.
• Analytical abilities required to identify and resolve underpayments relating to specific payers, coding issues, etc.
• Organizational skills with attention to detail are required