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Patient Refund Specialist

2 months ago

Nashville, United States Integrated Oncology Network, LLC Full time
Partnering With Physicians To Provide Best In Class Patient Care

Founded in 2002, Integrated Oncology Network is committed to helping our physicians deliver the right care, at the right time and in the right setting. We strongly believe that preserving the independent practice of medicine where patients are cared for closer to home and surrounded by our dedicated clinicians yields better outcomes. By creating a care continuum between our clinicians, patients and their support networks we deliver an unparalleled approach to the patient's care journey.

The Refunds Specialist analyzes data to determine whether or not a refund is warranted, based on contractual agreements and payments received, and administers refunds accordingly. The Credit/Refund Specialist will be responsible for the expedient and accurate refund processing of patient and insurance over payments.

Essential Functions:
  • Review EOBs and ensure allowances, adjustments, unallocated payments, and overpayments are posted correctly
  • Reviews refund requests submitted by the billing team for accuracy, before sending to the accounting department for processing.
  • Review and resolve accounts with credit balances/request refunds and/or adjustments as necessary
  • Generate reports to identify outstanding credit balances and prepare overpayment packages as necessary
  • Initiate and work up refund requests for overpayments
  • Process refunds and credit balances to patients or payers
  • Identify account problems, patterns, and trends
  • Assist with additional payment-related functions as necessary
  • Assist and respond to reports in a professional manner
  • Comply with state/federal regulations and adhere to HIPAA and PHI guidelines
  • Identify patient accounts with credit balances to determine whether or not a refund is due to the patient and/or insurance company.
  • Communicate refund status with patients/insurance companies.
  • Maintains refund tracking spreadsheet for all refund requests.
  • Follow up on requests submitted to ensure payment has been received.
  • Post adjustment and or payment corrections to patient accounts in billing software.
  • Perform other duties as assigned to meet business needs
Qualifications and Education Requirements

• 2+ years of experience working with medical refunds.

• High School Diploma or equivalent, Associate's Degree preferred

• Previous healthcare billing and/or payment posting experience required.
  • Basic computer knowledge (Windows, MS Word, MS Excel, Internet)
  • Comfortable with computer use, online resources, and learning new software

• Understanding of Electronic Response Admittances (ERAs) and Explanation of Benefits (EOBs)

• Strong Attention to details

• 10 Key by touch.

• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.

• Must be able to work as part of a team.

Preferred Skills

• Knowledge of medical terminology

• Knowledge of health insurance

• Familiar with Chemotherapy and Radiation Billing

Required Competencies

Ability to work in a team environment and be able to multi task. Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking. Ability to maintain a professional, polished image. Ability to communicate effectively, both written and verbal.