Refund & Adjustment Specialist

2 months ago

Green Bay, United States BayCare Clinic Full time

Come work where passion, quality, vision, professionalism, and synergy are valued BayCare Clinic's mission is to provide measurably superior specialty medical services to our patient

BayCare Clinic Corporate Headquarters is looking for a Refund and Adjustment Specialist to join our team in Green Bay, WI. We're looking for a compassionate, thoughtful candidate who wants to contribute to a positive experience for all our patients. This role has flexible 8-hour shifts between our core hours, Monday-Friday between 7:30 a.m. - 5:00 p.m. No Holidays No Weekends

The Clinic:

BayCare Clinic is a successful, dynamic group comprised of 19 specialties. We are a physician-owned entity with joint ownership in Aurora BayCare Medical Center, a 167-bed hospital located in Green Bay, WI, offering us a built-in referral base. Each of our specialty practices have clinical autonomy and are financially sound.

BayCare Clinic offers part-time and full-time employees a comprehensive benefits package including health, dental, disability and life insurance, as well as flexible spending options. We also offer a 401k retirement plan with a company match, generous PTO, and paid holidays.

The Team:

The unique skills and talents of each member of our team contributes to our synergy and our overall goal of providing our patients with excellent care. We believe in the power of a positive, collaborative culture, and we strive to provide a supportive and energizing work environment.

Every member of our team has a voice and is trusted to have ownership over their work. To encourage this, we provide regular opportunities for professional development, we seek out feedback and ideas, and we invite participation on a variety of projects.

The Job:

  • Ability to read and interpret explanation of benefits and insurance correspondence.
  • Notifies Supervisor of any trends or problems noted that could affect cash flow.
  • Research and process refund requests from insurance companies, including the recoupment of payment. Contacting payers via website, telephone, and or written correspondence.
  • Research all patient cash and credit card refunds in a timely manner.
  • Reviews various reports, updates, communicates, and will perform follow up.
  • Work closely with Accounts Payable each week reconciling refunds, forwarding requests with attached documentation, to ensure accurate and timely preparation.
  • Responsible for reviewing and approving adjustments received from Patient Accounts and clinic practice sites.
  • Adjusts accounts appropriately according to the BayCare contract, business guideline (s), and any specifics from the payer.
  • Is aware of payer specifics when processing refunds and adjustments.
  • Perform detailed audits timely, and as defined by Bay Care reimbursement contracts.
  • Responsible for accurate and timely preparation, review, submission, and follow-up of claims.
  • Contacts payers via website, telephone, and/or correspondence regarding reimbursement.
  • Review both underpayments and overpayments to identify payment trends or missed revenue opportunities.
  • Reviews incorrect discounts received from Payment Posting.
  • The ability to work reports, follow-up and provide updates when needed.
  • Responsible for the specific details regarding projects you are assigned too.
  • Stays current with payer specifics and contracts regarding reimbursement.
  • Follow up and place outbound calls to challenge payments and or reconsideration.
  • Identify problem payers and notify management of issues in a timely manner.
  • Respect and maintain confidentiality.
  • Work in a safe, compliant, and ethical manner at all times.
The Requirements:
  • At least 2-3 years' experience in patient account billing, prior account collection knowledge and expertise of medical terminology, CPT, ICD-9, HCPCS, RVU, coding and commercial billing is required.
  • EPIC knowledge preferred, but not necessary.
  • Knowledge of insurance principles and insurance contracts
  • Collection and negotiation skills.
  • General accounting principles, the ability to calculate figures such as discounts and percentages.
  • Proficient with Microsoft Word, Excel, and the internet.
  • Research and resolve payment discrepancies.
  • Requires written and verbal skills with the ability to communicate complex concepts.
  • Problem-solving skills, ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
  • Able to research and resolve payment discrepancies.
  • Self-starter with ability to work independently.
  • Strong organizational skills with ability to prioritize and complete projects.

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