RCM QA Specialist - Adjustments / Refunds

Let’s talk about Responsibilities

• Very good understanding of AR follow-up and denial management, to resolve outstanding issues and minimize AR aging processing appropriate write offs and adjustments.

• Accurately and timely adjustments and refund processing, into the billing system.

• Conduct thorough adjustments & refund reviews, ensuring accuracy and adherence to established procedures.

• Review accounts and resolve discrepancies in adjustments & refunds to ensure accurate financial records.

• Maintain a comprehensive understanding of US payer contracts, EOB/ERA codes, and adjustments to accurately review payments, credits and adjustments.

• Stay updated with changes in reimbursement policies, payer contracts, and industry regulations related to insurance write offs, adjustments and refund specific rules.

• Maintain documentation of adjustments and refund processes, procedures, and payer-specific guidelines.

• Participate in team meetings and provide input for process improvement initiatives.

• Attention to details for reviewing and following the relevant SOPs and instructions for adjustments and refund processes

• Assist with internal and external audits, ensuring compliance with regulatory and contractual obligations.

• Participate in quality control activities, conducting audits and providing recommendations for process improvements.

Let’s talk about Qualifications and Experience

Required:

• 2 years of hands-on experience in revenue cycle management within the DME/HME specialty.

• Strong knowledge and experience with AR follow-up and denial management processes.

• In-depth understanding of US payer management, including Medicare, Medicaid, and commercial insurance.

• Excellent written and verbal communication skills, with the ability to effectively communicate with internal teams, clients, and payers.

• Detail-oriented with exceptional analytical and problem-solving skills.

• Previous experience as an auditor and quality control specialist is preferred, but not mandatory.

• Ability to work independently and in a team-oriented environment.

• Strong organizational skills with the ability to prioritize tasks and meet deadlines.

• Up-to-date knowledge of coding and billing regulations, reimbursement guidelines, and industry trends.

Preferred:

• Bachelor’s degree.

• 2 years of related experience.

• Proficiency in using Brightree software is highly preferred.

• Developing professional expertise, applies company policies and procedures to resolve a variety of issues.

Joining us is more than saying “yes” to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now! We commit to respond to every applicant.